Effectiveness of Valsartan for Treatment of Hypertension: Patient Profiling and Hierarchical Modeling of Determinants and Outcomes (the Preview Study)

2009 ◽  
Vol 43 (5) ◽  
pp. 849-861 ◽  
Author(s):  
Patricia Van Der Niepen ◽  
Annemie Woestenburg ◽  
Heidi Brié ◽  
Stefaan Vancayzeele ◽  
Karen Macdonald ◽  
...  
Keyword(s):  
Hierarchical Modeling ◽  
Antihypertensive Agents ◽  
Diabetic Patients ◽  
Related Factors ◽  
Hypertensive Patients ◽  
Therapeutic Benefits ◽  
Treatment Of Hypertension ◽  
Patient Profiling ◽  
Pharmacologic Effect ◽  
The Impact

Background Patient- and clinician-related factors may explain variability in blood pressure (BP) outcomes and the differences between real-world effectiveness and efficacy seen in randomized trials of antihypertensive agents. Objective To examine the effectiveness of 90 days of second-line valsartan treatment and identify patient- and physician-level determinants that impact BP outcomes. Methods A prospective, multicenter, multilevel pharmacoepidemiologic study was conducted in 3194 hypertensive patients (systolic BP [SBP] ≥140 mm Hg, diastolic BP [DBP] ≥90 mm Hg; for diabetic patients, ≥130 and ≥80 mm Hg, respectively) treated by 504 general practitioners (GPs). Statistical analysis included heuristic data mining, and hierarchical linear and logistic modeling. Results With valsartan treatment, mean ± SD SBP decreased from 154.4 ± 15.5 mm Hg to 139.0 ± 12.0 mm Hg and mean DBP decreased from 91.3 ± 9.2 mm Hg to 82.6 ± 7.4 mm Hg. SBP control rates increased from 9.0% to 38.6%, DBP from 25.5% to 65.5%, and combined SBP/DBP from 7.3% to 34.4%. A highly vulnerable cohort (n = 1063;35.4%) of patients was identified. Twenty-four percent of variability in SBP and 25% of variability in DBP at 90 days were attributable to physician-related variables: guideline-compliant BP management, hypertension, practice patterns, hypertensive patient volume, and years in practice. The remaining 76% and 75% of variability in SBP and DBP, respectively, were due to patient factors, notably diabetes and related complications, vulnerability to uncontrolled BP, nonadherence, cardiovascular risk, and age. Simitar factors increased the odds of treatment nonresponse, with diabetes being the single largest determinant of uncontrolled SBP (OR 8.99), DBP (OR 20.35), and combined SBP/DBP (OR = 18.64). Conclusions Valsartan is effective and well tolerated in a broad range of patients in whom first-line antihypertensive treatment failed or was not tolerated. Mitigating the impact of BP-elevating variables and optimizing the effect of BP-lowering factors provides therapeutic benefits incremental to valsartan's pharmacologic effect. Improving outcomes in hypertensive patients involves 3 steps: (1) identifying, intuitively rather than formally, patients less likely to achieve BP control; (2) targeting modifiable or manageable patient- and physician-level determinants with BP-elevating or BP-lowering effects; and (3) managing variables that increase the odds and optimizing those that lower the odds of uncontrolled BP.

scholarly journals Usage of diuretics among diabetic-hypertensive patients

2014 ◽  
Vol 6 (2) ◽  
pp. 14-17
Author(s):  
Rajeshwari Shastry ◽  
M.R. Prabha Adhikari ◽  
Sheetal D. Ullal ◽  
Shashidhar Kotian
Keyword(s):  
Glycemic Control ◽  
Tertiary Care ◽  
Vascular Complications ◽  
Cross Sectional Study ◽  
Drug Combinations ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Aggressive Approach ◽  
Hypertensive Patients ◽  
Treatment Of Hypertension

Background: Hypertension is more common in diabetics than in non-diabetic patients. An aggressive approach to the diagnosis and treatment of hypertension in patients with diabetes is required in order to substantially reduce the incidence of both macro-vascular and micro-vascular complications. The role of diuretics in the treatment of hypertension as first line or second line drugs is a provoking debate, hence we studied the usage of diuretics and their effects on BP and glycemic control among diabetic-hypertensive patients.Methods: This cross sectional study was carried out for a period of six months in a tertiary care teaching hospital. Patients’ details such as age, gender, height, weight, comorbid diseases, blood pressure, eGFR along with duration of diabetes and hypertension and drugs prescribed for hypertension were noted. Data were analyzed using descriptive statistics.Results: A total of 336 diabetic-hypertensiveswith a mean age of 64.55±9.51 years were included. Fortyfive patients were on diuretics,two (4.4%) of whom were on diuretic monotherapy, 16 (35.6%) on two drug combinations (Diuretic + ACEI or ARB), 21 (46.7%) on three drug combinations (diuretics + ARB & BBs or diuretic + ACEI & BB or diuretic + ARB &CCB) and six (13.3%) were on four drug combinations (diuretics + ARB, CCB & BB). Among the patients on diuretic combination therapy BP was well controlled in 23 (51%) patients and the glycemic control was comparable to those not on diuretics.Conclusion: In the present study the usage of diuretics was consistent with the guidelines. About 13% of diabetic-hypertensive patients were on diuretic treatment. The control of BP in patients on diuretics was not satisfactory, but there was no worsening of glycemic control compared to other antihypertensive therapy. This shows that low dose thiazides in combination with other antihypertensives can be safe in diabetic-hypertensive patients however their efficacy needs further scrutiny. DOI: http://dx.doi.org/10.3126/ajms.v6i2.10582Asian Journal of Medical Sciences Vol.6(2) 2015 15-18

scholarly journals The Impact of COVID-19 on Diabetes Mellitus and Hypertension: A Retrospective Study

2021 ◽  
pp. 68-77
Author(s):  
S. Pavithra ◽  
S. Lavanya ◽  
P. Vaishnavi ◽  
A. Rakesh Rosario ◽  
Priyadharshini A ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Retrospective Study ◽  
Diabetic Patients ◽  
Hypertensive Patients ◽  
Study Population ◽  
The Impact

COVID-19 is a pathogenic virus that caused a pandemic outbreak in December 2019. The impact of this virus may be severe in the patients having co-morbidities like diabetes, hypertension, Chronic Kidney Disease, cardiovascular disease, etc. Aim and Objectives: This study Aims in Assessing the impact of COVID-19 on Diabetic and Hypertensive patients as well as COVID-19 patients without any co-morbidities. Objective of this is to evaluate the association between COVID-19 and its risk factors (diabetes and hypertension) and to evaluate whether the severity of the symptoms in COVID-19 patients is due to comorbidities or past medications. Methodology: A Retrospective study was conducted in SRM Hospital (Medical Records Department) for a period of 3 Months with the study population 670 at the age group of 25, known case of Diabetes and Hypertension. Cases of Pregnant women are excluded from the study. The patients were grouped into 4 categories 1) control group (patient without any co-morbidities) 2) diabetic patients 3) Hypertensive patient 4) Diabetic+Hypertension patient and studied their prescribing pattern by collecting the past medication history. Results and Discussion: There is a significant decrease in a lymphocyte in covid-19 Type 2 diabetic patients in our study. These results suggest that different mechanism exists for hypertension and diabetes mellitus as risk factors for covid-19. It is also known that these patients have impaired immune response to many infections [30]. In our retrospective study, we collected 670 covid-19 cases. It consists of 12.5% of diabetic patients and 6.6% of hypertensive patients. This study compared COVID-19 patients without any comorbidity (neither Type 2 diabetes mellitus nor hypertension) with covid- 19 patients with comorbidities (Type 2 diabetes mellitus and hypertension). COVID-19 patients with T2DM have an increased level of D-dimer compared to non-T2DM patients. Conclusion: Diabetic and hypertensive patients affected with COVID-19 are low in our study. Out of the total study population, only 12.5% are diabetic, 6.56% are hypertensive, and 9.25% were both diabetic and hypertensive. But when comparing in terms of severity, hypertensive and diabetic patients have severe effects than the control patients. In simpler terms, not every person who has diabetes and hypertension are affected with COVID-19, but those who were affected by COVID-19 showed more severity than the patients who don't have any comorbidities

scholarly journals Survival Analysis of Hospitalized Elderly People with Fractures in Brazil Over One Year

Geriatrics ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 10
Author(s):  
Brenda Kelly Gonçalves Nunes ◽  
Brunna Rodrigues de Lima ◽  
Lara Cristina da Cunha Guimarães ◽  
Rafael Alves Guimarães ◽  
Claci Fátima Weirich Rosso ◽  
...  
Keyword(s):  
Elderly People ◽  
Cox Regression ◽  
Age Groups ◽  
The Elderly ◽  
Diabetic Patients ◽  
Related Factors ◽  
Hospitalized Elderly ◽  
Study Results ◽  
One Year ◽  
The Impact

Objective: This study analyzes the causes of death, survival, and other related factors in hospitalized elderly people with fractures over the course of one year. Methods: We followed 376 fracture patients for one year in a prospective cohort study to a reference hospital in central Brazil. The Cox regression model was used to analyze factors associated with survival. Results: The results indicate that the one-year mortality rate was high (22.9%). The independent factors linked to lower overall survival were as follows: patients aged ≥80 years with previous intensive care unit (ICU) admission and presence of comorbidities (diabetes mellitus [DM] and dementia). Conclusion: Our study results may contribute to a better understanding of the impact of fractures on the elderly population and reinforce the need to oversee age-groups, diabetic patients, and patients with complications during hospitalization.

scholarly journals The Impact of Antihypertensive Agents on Health-Related Quality of Life of Hypertensive Patients

2021 ◽  
Vol 4 (1) ◽  
pp. p7
Author(s):  
Wajeeha Siddique ◽  
Noman Haq ◽  
Maria Tahir ◽  
Ghulam Razzaque Razaque
Keyword(s):  
Quality Of Life ◽  
Health Outcomes ◽  
Ace Inhibitors ◽  
Antihypertensive Agents ◽  
Health Related Quality ◽  
Hypertensive Patients ◽  
Related Quality ◽  
Health Related ◽  
The Impact

Chronic diseases and their treatment regimen plays a greater role in determining the patient related health outcomes of which one is Health Related Quality of Life. Hypertension itself along with its pharmacotherapy impacts HRQoL of hypertensive patients. The primary objective of the study was to determine the impact of f hypertensive medications on the health-related quality of life among hypertensive patients with the secondary objective to assess which medication significantly affects health related quality of life of hypertensive patients. A quantitative questionnaire based cross-sectional survey was undertaken in outpatient departments of Sandeman Provisional Hospital (SPH) Quetta using an EQ-5D-3L to determine the Health-Related Quality of Life. Convenience Sampling technique was used for data collection. Majority of respondents (8.7%) had no problem in first three domains while having some problem in pain and anxiety domains. Following them 7.6% of patients had some problems in all domains of the EQ5D tool. Moreover. the ACE Inhibitors and Diuretics impacts HRQoL of patients of current study. A total of 263 participated in the study of which (25%) of the respondents were of age group 48 -75 years old and were married 73.4% mostly. Majority (8.7%) had no problem in first three domains while having some problem in pain and anxiety domains. ACE Inhibitors and Diuretics significantly influence the health status of hypertensive patients acquiring pharmacotherapy. It was concluded that antihypertensive agents have a significant impact on HRQoL of hypertensive patients especially Angiotensin Converting Enzymes and Diuretics, which show significant impact on HRQoL of hypertensive patients. However, it is also suggested to assess the impact of antihypertensive therapies given in combination must also be studied in order to provide health professionals a better understanding of their prescribed regimen to improve patient related health outcomes.

scholarly journals The Impact of Diabetes on Outcomes and Health Care Costs Following Anterior Cervical Discectomy and Fusion

2020 ◽  
pp. 219256822096405
Author(s):  
William H. Shuman ◽  
Sean N. Neifert ◽  
Jonathan S. Gal ◽  
Daniel J. Snyder ◽  
Brian C. Deutsch ◽  
...  
Keyword(s):  
Cost Of Care ◽  
Anterior Cervical Discectomy ◽  
Bleeding Complications ◽  
Diabetic Patients ◽  
Complication Rates ◽  
Related Factors ◽  
Cervical Discectomy ◽  
Prolonged Length ◽  
Spine Pathology ◽  
The Impact

Study Design: Retrospective cohort study. Objectives: Anterior cervical discectomy and fusion (ACDF) is commonly used to treat an array of cervical spine pathology and is associated with good outcomes and low complication rates. Diabetes mellitus (DM) is a common comorbidity for patients undergoing ACDF, but the literature is equivocal about the impact it has on outcomes. Because DM is a highly prevalent comorbidity, it is crucial to determine if it is an associated risk factor for outcomes after ACDF procedures. Methods: Patients at a single institution from 2008 to 2016 undergoing ACDF were compared on the basis of having a prior diagnosis of DM versus no DM. The 2 cohorts were compared utilizing univariate tests and multivariate logistic and linear regressions. Results: Data for 2470 patients was analyzed. Diabetic patients had significantly higher Elixhauser scores ( P < .0001). Univariate testing showed diabetic patients were more likely to suffer from sepsis (0.82% vs 0.10%, P = .03) and bleeding complications (3.0% vs 1.5%, P = .04). In multivariate analyses, diabetic patients had higher rates of non–home discharge (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.07-1.75, P = .013) and prolonged length of stay (OR = 1.95, 95% CI = 1.25-3.05, P = .003), but similar complication (OR = 1.46, 95% CI = 0.85-2.52, P = .17), reoperation (OR = 0.77, 95% CI = 0.33-1.81, P = .55), and 90-day readmission (OR = 1.53, 95% CI = 0.97-2.43) rates compared to nondiabetic patients. Direct cost was also shown to be similar between the cohorts after adjusting for patient, surgical, and hospital-related factors (estimate = −$30.25, 95% CI = −$515.69 to $455.18, P = .90). Conclusions: Diabetic patients undergoing ACDF had similar complication, reoperation, and readmission rates, as well as similar cost of care compared to nondiabetic patients.

Advantages and Benefits of Once-Daily Nadolol Treatment in Hypertension

1982 ◽  
Vol 10 (5) ◽  
pp. 351-356
Author(s):  
Diego González
Keyword(s):  
Combination Therapy ◽  
Patient Compliance ◽  
Antihypertensive Therapy ◽  
Open Study ◽  
Antihypertensive Agents ◽  
Efficacy And Safety ◽  
Once Daily ◽  
Hypertensive Patients ◽  
Treatment Of Hypertension ◽  
Therapeutic Responses

This multicentre, open study was conducted in 263 hypertensive patients from six different countries by seventeen investigators. The results confirm the efficacy and safety of nadolol, used alone or in combination therapy in the treatment of hypertension, even inpatients in whom previous antihypertensive therapy with other drugs was unsatisfactory. The study also demonstrated that nadolol can effectively replace a variety of other antihypertensive agents, and, because of once a day dosage, can enhance patient compliance and produce better therapeutic responses.

scholarly journals Impact of antihypertensive agents on clinical course and in-hospital mortality: analysis of 169 hypertensive patients hospitalized for COVID-19

2020 ◽  
Vol 66 (suppl 2) ◽  
pp. 71-76 ◽  
Author(s):  
Ibrahim Kocayigit ◽  
Havva Kocayigit ◽  
Selcuk Yaylaci ◽  
Yusuf Can ◽  
Ali Fuat Erdem ◽  
...  
Keyword(s):  
Antihypertensive Agent ◽  
Clinical Course ◽  
Beta Blockers ◽  
Antihypertensive Agents ◽  
Binary Logistic Regression Analysis ◽  
Hypertensive Patients ◽  
Alpha Blockers ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

SUMMARY OBJECTIVE Coronavirus disease 2019 (COVID-19) is an emerging health threat caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Previous studies have noted hypertension is associated with increased mortality due to COVID-19; however, it is not clear whether the increased risk is due to hypertension itself or antihypertensive agents. We aimed to evaluate the impact of antihypertensive agents on the clinical outcomes of hypertensive patients with COVID-19. METHODS Our study included 169 consecutive hypertensive patients hospitalized due to COVID-19 between March 20 and April 10, 2020. The demographic characteristics, clinical data, and type of antihypertensive agents being used were reviewed. RESULTS The mean age of patients was 65.8±11.7 years.30 patients(17.7%) died during hospitalization. A total of 142 patients(84%) were using angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), 91 (53.8%) were using diuretics, 69 (40.8%) were using calcium channel blockers (CCBs), 66 (39.1%) were using beta-blockers, 12 (7.1%) were using alpha-blockers, and 5 (2.9%) were using mineralocorticoid receptor antagonists (MRAs). There was no significant difference between survivors and non-survivors based on the type of antihypertensive agents being used. Binary logistic regression analysis showed that the type of the antihypertensive agent being used had no effect on mortality [OR=0.527 (0.130-2.138), p=0.370 for ACEIs/ARBs; OR=0.731 (0.296-1.808), p=0.498 for CCBs; OR=0.673 (0.254-1.782), p=0.425 for diuretics; OR=1.846 (0.688-4.950), p=0.223 for beta-blockers; OR=0.389 (0.089-1.695), p=0.208 for alpha-blockers; and OR=1.372 (0.107-17.639), p=0.808 for MRAs]. CONCLUSION The type of antihypertensive agent being used had no effect on the clinical course and mortality in hypertensive patients with COVID-19. The use of these agents should be maintained for the treatment of hypertension during hospitalization.

Metabolic syndrome and exaggerated blood pressure response to exercise in newly diagnosed hypertensive patients

2011 ◽  
Vol 19 (3) ◽  
pp. 467-473 ◽  
Author(s):  
Costas Tsioufis ◽  
Alexandros Kasiakogias ◽  
Dimitris Tsiachris ◽  
Athanasios Kordalis ◽  
Costas Thomopoulos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Blood Pressure Response ◽  
Pressure Response ◽  
Peak Exercise ◽  
Diabetic Patients ◽  
Newly Diagnosed ◽  
Hypertensive Patients ◽  
Response To Exercise ◽  
The Impact

Background: Running evidence supports a prognostic value of an exaggerated blood pressure response to exercise (EBPR). The impact of the metabolic syndrome (MS) on EBPR in hypertensive patients has not been investigated. Design: A cross-sectional study in the setting of an outpatient hypertension clinic. Methods: In total, 325 non-diabetic patients with newly diagnosed hypertension were divided into two groups based on the presence ( n = 95) or absence ( n = 230) of the MS as defined with NCEP-ATP III criteria. All subjects underwent ambulatory blood pressure monitoring, echocardiography and exercise treadmill testing. Results: Hypertensive patients with MS exhibited higher prevalence of EBPR (by 17%, p = 0.002) and peak exercise systolic BP (by 10.4 mmHg, p = 0.001) irrespectively of confounders. Metabolic equivalents were higher in hypertensives with MS (by 0.6 ml/kg/min, p = 0.048), but the difference lost significance after adjusting for confounders, including body mass index. Logistic regression analysis identified the MS as an independent predictor of an EBPR ( p = 0.016). Hypertensive patients with MS had a 2.3-fold risk of exhibiting EBPR compared to those without MS. However, individual components of MS altogether as well as each one separately failed to predict EBPR. Conclusions: Presence of MS in newly diagnosed hypertensive patients is associated with increased peak exercise BP and a higher frequency of EBPR over and above its separate elements.

A Study On Impact Of Work Life Related Factors On Employee Engagement In Health Care Sector Workers In Dindigul District.

2019 ◽  
Vol 118 (7) ◽  
pp. 20-26
Author(s):  
S. JAYARAMAN ◽  
R. Sindhya ◽  
P. Vijiyalakshmi
Keyword(s):  
Health Care ◽  
Path Analysis ◽  
Employee Engagement ◽  
Health Care Workers ◽  
Health Care Sector ◽  
Work Life ◽  
Primary Data ◽  
Related Factors ◽  
Care Workers ◽  
The Impact

this research aims to find out the intensity of Employee Engagement of the health care sector workers and the relationship between the Work life factors and Employee Engagement of Health care sector workers in Dindigul District. Primary data were used in this research, were collected from 298 Health care workers from Dindigul District. Questionnaire was the major tool used to gather the primary data from the selected sample respondents. For this purpose, a well structured questionnaire was constructed with the help of professionals and the practiced employees of various health care units in Dindigul District. The health care employees were chosen by simple random sampling method. The investigative measures of regression Path analysis, and simple percentage analysis were utilized to find the impact of work life related factors with the Employee Engagement. The maximum Health care workers were generally satisfied with their jobs. The analytical procedure of path analysis multiple regressions was utilized to determine the predicting strength among Work life factors and the employee engagement. This study provides an another view about the importance of Work life factors and Employee engagement for organizational effectiveness and performance .

Aortic Stenosis, Aortic Regurgitation and Arterial Hypertension

2019 ◽  
Vol 17 (2) ◽  
pp. 180-190 ◽  
Author(s):  
V. Katsi ◽  
G. Georgiopoulos ◽  
D. Oikonomou ◽  
C. Aggeli ◽  
C. Grassos ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Antihypertensive Agents ◽  
Renin Angiotensin System ◽  
Aortic Disease ◽  
Review Of The Literature ◽  
Angiotensin System ◽  
The Impact ◽  
Worse Prognosis

Background: Hypertension (HT) is an important risk factor for cardiovascular disease and might precipitate pathology of the aortic valve. </P><P> Objective: To investigate the association of HT with aortic dysfunction (including both aortic regurgitation and stenosis) and the impact of antihypertensive treatment on the natural course of underlying aortic disease. </P><P> Methods: We performed a systematic review of the literature for all relevant articles assessing the correlation between HT and phenotype of aortic disease. </P><P> Results: Co-existence of HT with aortic stenosis and aortic regurgitation is highly prevalent in hypertensive patients and predicts a worse prognosis. Certain antihypertensive agents may improve haemodynamic parameters (aortic jet velocity, aortic regurgitation volume) and remodeling of the left ventricle, but there is no strong evidence of benefit regarding clinical outcomes. Renin-angiotensin system inhibitors, among other vasodilators, are well-tolerated in aortic stenosis. </P><P> Conclusion: Several lines of evidence support a detrimental association between HT and aortic valve disease. Therefore, HT should be promptly treated in aortic valvulopathy. Despite conventional wisdom, specific vasodilators can be used with caution in aortic stenosis.

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