Use of Antihypertensive and Antithrombotic Medications after Stroke in Community-Based Care

2001 ◽  
Vol 35 (7-8) ◽  
pp. 811-816 ◽  
Author(s):  
Sally K Rigler ◽  
Melissa J Webb ◽  
Atul T Patel ◽  
Sue Min Lai ◽  
Pamela W Duncan
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Antihypertensive Medication ◽  
Medication Use ◽  
Antihypertensive Agents ◽  
Channel Blockers ◽  
Community Based ◽  
Converting Enzyme Inhibitors ◽  
Stroke Study ◽  
Blood Pressures

BACKGROUND: Secondary stroke prevention strategies include pharmacologic approaches to control hypertension and reduce thromboembolic risk. OBJECTIVE: To describe antithrombotic and antihypertensive medication use, and rates of blood pressure control in the Kansas City Stroke Study, a prospective stroke cohort receiving community-based care after primarily mild and moderate stroke. METHODS: Participants from 12 area hospitals provided information about medication use prior to stroke. Study personnel measured blood pressures at enrollment and at one, three, and six months, and collected medication data at six months during in-home assessment. RESULTS: Complete data at six months were available for 355 subjects with ischemic stroke, among whom 13% had atrial fibrillation and 67% had prior hypertension. Prior to stroke, only 45% of the patients were receiving any antithrombotic (anticoagulant and/or antiplatelet) therapy; this figure rose to 77% at six months. Antithrombotic treatment rates among those with atrial fibrillation were 59% before stroke and 83% at six months, including warfarin in 64%. Approximately 70% of subjects had controlled blood pressures one, three, and six months after stroke, defined as systolic blood pressure ≤140 mm Hg and diastolic blood pressure ≤90 mm Hg. Use of multiple antihypertensive agents was common; calcium-channel blockers and angiotensin-converting enzyme inhibitors were used most frequently. However, 19% of subjects with uncontrolled blood pressure were untreated at six months. CONCLUSIONS: Although room for improvement remains, these data suggest improved rates of antithrombotic and antihypertensive medication use after stroke in community-based care in a midwestern metropolitan community, compared with previous reports.

Abstract 3783: Antihypertensive Medications in the Department of Veterans Affairs (VA) 1999–2006

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Julio R Lopez ◽  
Sonya Wong ◽  
Joy L Meier ◽  
Fran Cunningham ◽  
David Siegel
Keyword(s):  
Antihypertensive Medication ◽  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Medication Use ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Steady Increase ◽  
Channel Blockers ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors

Objective: To evaluate national antihypertensive medication use we collected data from 2003–2006 and compared it to previously collected data from 1999 –2002. We examine the cost implications of shifts in antihypertensive medications prescribed. Methods: National VA pharmacy data were used to determine the use of beta blockers (BB), calcium channel blockers (CCB), thiazide diuretics (TD) alone or with K sparing diuretics, angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and combinations of the aforementioned classes for 2003–2006. Total number of treatment days, determined from days supply of the prescription, was used to determine patterns of use over time. Results: Antihypertensive medication use in the VA represented more than 1.5 billion days in 2006 and increased 2.5 fold from the 577 million estimated for 1999. ACEI were most commonly used, representing 31.8% and 31.7% of treatment days in 1999 and 2006, respectively. In the ACEI class lisinopril is the most commonly used drug. Increases in use from 1999 to 2006 were 21.2% to 25.2% for BB, 14.4% to 17.8% for TD, and 1.2% to 5.2% for ARB. Decreases in use from 1999 to 2006 were 26.7% to 17.6% for CCB. The decline in CCB was inversely correlated to the increase in BB or TD (p<0.001). Shifts in medication use are estimated to save the VA $33 million annually. Conclusions: ACEI remain the most prescribed antihypertensive drug class in the VA, followed by BB, TD, CCB, and ARBs. TD use shows a slow steady increase while CCB use continues to decline. These findings suggest that VA has increasing adherence to JNC7 and VA HTN guidelines.

scholarly journals Pattern of Medication Prescribing and Factors Associated with Meeting of Target Blood Pressure among Persons with Hypertension in Federal Police Referral Hospital, Ethiopia

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Tariku Shimels
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Agents ◽  
Structured Interview ◽  
Referral Hospital ◽  
Channel Blockers ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors ◽  
Cross Sectional ◽  
Factors Associated ◽  
Study Participants

Introduction: Hypertension is one of the highly growing chronic health challenges worldwide causing a significant number of deaths and cardiovascular complications. The prevalence of the condition in Ethiopia was estimated to be 19.5% with an urban and rural subgroup proportion of 25.7% and 14.7% respectively. This study was conducted to assess the pattern of prescribing antihypertensive medications and factors associated with BP target meeting among persons with hypertension in Federal Police Referral Hospital. Method: An institution based cross sectional study was conducted from 15th October 2016 to 15th January 2017. A systematic random sampling technique was employed in selecting the study participants. Data was collected using a semi-structured interview of study participants and visiting medication records. SPSS version 20 was used for data entry and analysis. Results: Of the 330 subjects required to be included in the study, 318 (96.4%) fulfilled the inclusion criteria and were considered for further analysis. Diuretics were the top prescribed class of antihypertensive agents accounted by 201(63.2%) of the subjects. Hydrochlorothiazide, a thiazide diuretic, was the most frequent. Next highly utilized classes of drugs included; calcium channel blockers among 172 (54.1%) subjects followed by angiotensin converting enzyme inhibitors prescribed for 153 (48.1%) participants. Target meeting for the systolic and diastolic blood pressure accounted for 142 (44.7%) and 140(44%) of the study subjects respectively. Overall target meeting of the two variables was attained by 103(32.4%) of the participants. Conclusion: Diuretics were the class of drugs most frequently prescribed succeeded by CCBs and ACEIs. The result of this study has also shown that overall BP target meeting among the subjects was suboptimal. Multivariate binary logistic regression has shown that gender, duration of therapy and dietary adherence were associated with BP target meeting.

The Clinical Pharmacy Specialists’ Role in Antihypertensive Management Surrounding Bariatric Surgery in a Veterans Affairs Population

2021 ◽  
pp. 089719002110150
Author(s):  
Jessica L. O’Neill ◽  
Rachel A. Pinkney ◽  
Kathryn M. Hurren
Keyword(s):  
Bariatric Surgery ◽  
Clinical Pharmacy ◽  
Antihypertensive Medication ◽  
Medical Center ◽  
Antihypertensive Agents ◽  
Veterans Affairs ◽  
Primary Objective ◽  
Channel Blockers ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors

Background: No guidelines exist for de-escalating antihypertensive medications surrounding bariatric surgery. This study analyzed clinical pharmacy specialist (CPS) management of antihypertensive medications in patients undergoing bariatric surgery at a Veterans Affairs medical center. Objectives: The primary objective was to describe the CPS role in antihypertensive management surrounding bariatric surgery through evaluation of number of CPS encounters, number and type of antihypertensive medications and medication interventions by CPSs and all other providers, over 5 time periods between a pre-operative assessment and up to 6 months post-operatively. Methods: Electronic medical records of patients taking antihypertensive medication who underwent bariatric surgery between 1/1/2014 and 2/27/2018, had primary care through our facility, and at least 1 encounter with a CPS were reviewed. Results: Forty patients were included out of 221 screened. There were 109 total medication interventions in 37 patients. CPSs provided 60 medication interventions (55% of total interventions) in 26 patients. Mean antihypertensive agents per patient was 2.18 at baseline versus 0.95 at 6-months post-operative. Dihydropyridine calcium channel blockers had the highest discontinuation rate. Thiazide diuretics were most commonly discontinued prior to surgery and angiotensin converting enzyme inhibitors were discontinued more steadily over the study duration. Nineteen patients (48.7%) had blood pressure <140/90 mmHg and were off all antihypertensive medications at the final CPS encounter. Conclusion: The results of this small study support the role of CPSs in antihypertensive medication management surrounding bariatric surgery.

scholarly journals Control of blood pressure and cardiovascular outcomes in type 2 diabetes

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 304-323 ◽  
Author(s):  
Hernando Vargas-Uricoechea ◽  
Manuel Felipe Cáceres-Acosta
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Angiotensin Receptor Blockers ◽  
Pharmacological Therapy ◽  
Current Evidence ◽  
Diabetic Patients ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Patients With Diabetes ◽  
The Impact

AbstractHigh blood pressure in patients with diabetes mellitus results in a significant increase in the risk of cardiovascular events and mortality. The current evidence regarding the impact of intervention on blood pressure levels (in accordance with a specific threshold) is not particularly robust. Blood pressure control is more difficult to achieve in patients with diabetes than in non-diabetic patients, and requires using combination therapy in most patients. Different management guidelines recommend initiating pharmacological therapy with values >140/90 mm/Hg; however, an optimal cut point for this population has not been established. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90mmHg, and that values approaching 130/80mmHg should be recommended. Initial treatment of hypertension in diabetes should include drug classes demonstrated to reduce cardiovascular events; i.e., angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, diuretics, or dihydropyridine calcium channel blockers. The start of therapy must be individualized in accordance with the patient's baseline characteristics, and factors such as associated comorbidities, race, and age, inter alia.

Abstract MP61: Greater Late-life Physical Function Declines Among Older Adults With Higher Blood Pressure In Mid-life: The Atherosclerosis Risk In Communities (ARIC) Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Laura Skow ◽  
J Coresh ◽  
J Deal ◽  
Rebecca F Gottesman ◽  
Jennifer Schrack ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Physical Function ◽  
Antihypertensive Medication ◽  
Medication Use ◽  
Late Life ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Continuous Analysis ◽  
Aric Study

Introduction: Greater late-life physical function decline is associated with incident adverse outcomes including disability and death. Hypertension is the strongest risk factor for stroke, the major cause of physical disability. Hypertension in mid-life has previously been associated with poor physical functioning in late-life; however, more evidence is needed to evaluate whether higher blood pressure in mid-life is associated with the rate of physical function decline during late-late in the absence of stroke. We hypothesized that elevated blood pressure in mid-life would be associated with greater physical function declines in late life. Methods: We studied 5,559 older adults in the ARIC Study (Visit 5; mean age: 75.8 years; range: 66.7-90.9 years; 58% women; 21% Black/79% White) without prior stroke or Parkinson disease who completed the Short Physical Performance Battery (SPPB, scored 0-12). Repeated SPPB assessments occurred at Visits 6 and 7 (median follow-up: 4.2 years). The exposure was a history of elevated blood pressure (BP) (Visit 1; mean age: 52.0 years; mean gap between mid- and late-life exams: 23.7 years). BP was modeled both categorically (hypertensive: SBP 140+ mmHg, DBP 90+ mmHg, or antihypertensive medication use; pre-hypertensive: SBP 120-139 mmHg or DBP 80-89 mmHg; else normotensive) and continuously. Random-slope, random-intercept mixed models with an independent covariance structure tested the association between BP and SPPB score change, adjusted for age, sex, race-site, BMI, education, heart disease and heart failure. Continuous analysis also adjusted for antihypertensive medication use. Results: SPPB scores declined an average of 1.60 points per 10 years (95% CI: -1.75, -1.46; p<0.001) among older adults who were normotensive in mid-life. Older adults with a previous measurement of hypertension declined an additional 0.94 points per 10 years (95% CI: -1.27, -0.60; p<0.001). Prehypertension was not statistically significantly associated with additional decline compared to mid-life normotension (estimate: -0.19 SPPB points/10 years; 95% CI: -0.53, 0.16; p=0.293). In the continuous analysis, each additional 10 mmHg higher mid-life systolic blood pressure above 120 mmHg was associated with an additional 0.24 point decline in SPPB per 10 years in late-life (95% CI: -0.31,-0.14; p<0.001). Conclusions: Elevated BP in mid-life provides insight into the rate of physical function decline decades later, with higher mid-life systolic blood pressure corresponding with steeper declines in late-life physical function even in the absence of stroke. Future research should investigate whether elevated blood pressure at multiple points in mid-life further informs the association.

Antiproteinuric effects of antihypertensive agents in non-diabetic hypertensive population

Open Medicine ◽  
2008 ◽  
Vol 3 (3) ◽  
pp. 287-293
Author(s):  
Zorica Jovic ◽  
Vidojko Djordjevic ◽  
Karin Vasic ◽  
Snezana Cekic ◽  
Jankovic Irena
Keyword(s):  
Blood Pressure ◽  
Calcium Channel ◽  
Antihypertensive Drug ◽  
Calcium Channel Blockers ◽  
Ace Inhibitors ◽  
Statistical Significance ◽  
Antihypertensive Agents ◽  
Channel Blockers ◽  
Significant Difference ◽  
Change In Mean

AbstractArterial hypertension and proteinuria are important factors associated with the progression of both diabetic and nondiabetic chronic kidney disease. The objective of the present study was to determine the influence of different antihypertensive drug groups on urinary albumin excretion (UAE) as related to blood pressure in non-diabetic population. Subjects (n=39) with chronic renal disease accompanied by mild to moderate hypertension and varying degrees of proteinuria were divided into 3 groups based on UAE values and placed on nonpharmacological and/or treatment with an antihypertensive drug regimen (consisting of one or more antihypertensive drugs [beta blocker, ACE inhibitor or calcium-channel blocker]) to achieve a target blood pressure ≤ 130/85 mmHg. Periodic UAE measurements were performed. A reduction was observed over time in most patients, however, it reached statistical significance only in the microalbuminuric group (P<0.01). Patients were further stratified into 5 groups depending on assigned therapy: 0, nonpharmacological treatment; 1-drug group 1; 12-drug groups 1 and 2; 13-drug groups 1 and 3; 123-all 3 drug groups (1-ACE inhibitors, 2-beta blockers, 3-calcium channel blockers). A statistically significant change in mean UAE values at the start and end of the study period in patients assigned to drug groups 12, 13, and 123 was achieved (P < 0.05). Also, there was a statistically significant difference in the average reduction of proteinuria under varying antihypertensive drug regimens (P < 0.05). In conclusion, in patients with hypertension, changes in UAE depend on initial UAE values and administered antihypertensive treatment. ACE inhibitors combined with calcium channel blockers resulted in a higher UAE reduction than other drug groups.

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.

Risk of Cerebral Hypoperfusion with Antihypertensive Therapy

DICP ◽  
1989 ◽  
Vol 23 (12) ◽  
pp. 957-962 ◽  
Author(s):  
Susan C. Eagan ◽  
Lance W. Payne ◽  
Susan C. Houtekier
Keyword(s):  
Antihypertensive Therapy ◽  
Antihypertensive Medication ◽  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cerebral Hypoperfusion ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Populations At Risk ◽  
Treatment Of Hypertension

The effective treatment of hypertension is a major factor in the declining incidence of stroke in North America. There are subsets of patients, however, in which antihypertensive therapy may actually cause cerebral ischemia and infarction. Elderly patients and those with malignant hypertension, acute stroke, and occlusive cerebrovascular disease appear to be the populations at greatest risk of iatrogenic stroke. This article reviews the effect of beta-blockers, angiotensin-converting enzyme inhibitors, direct vasodilators, and calcium-channel blockers on cerebral blood flow in various populations. Although many investigations have been performed, it remains difficult to predict the risk of cerebral hypoperfusion due to antihypertensive medication in an individual patient. It is best for practitioners to be aware of the patient populations at risk and treat high blood pressure cautiously in these patients.

Sign in / Sign up

Export Citation Format

Share Document