scholarly journals Methods of defining hypertension in electronic medical records: validation against national survey data

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Mingkai Peng ◽  
Guanmin Chen ◽  
Gilaad Kaplan ◽  
Lisa Lix ◽  
Neil Drummond ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Drug ◽  
Medical Records ◽  
Antihypertensive Drugs ◽  
Cost Effective ◽  
Drug Prescriptions ◽  
Health Improvement ◽  
Diagnosis Code ◽  
Treatment Rate ◽  
Case Definitions

ABSTRACTObjectivesElectronic medical records (EMR) can be a cost-effective source for hypertension surveillance. However, diagnosis of hypertension in EMR is commonly under-coded and warrants the needs to review blood pressure and antihypertensive drugs for hypertension case identification. To advocate for the use of EMR data for research, we developed methods for defining hypertension using diagnosis codes, blood pressure measurements and antihypertensive drug prescriptionApproachWe included all the patients actively registered in The Health Improvement Network (THIN) database, UK, on 31 December 2011. Three case definitions using diagnosis code, antihypertensive drug prescriptions and abnormal blood pressure, respectively, were used to identify hypertension patients. We compared the prevalence and treatment rate of hypertension in THIN with results from Health Survey for England (HSE) in 2011. ResultsCompared with prevalence reported by HSE (29.7%), the use of diagnosis code alone (14.0%) underestimated hypertension prevalence. The use of any of the definitions (38.4%) or the combination of antihypertensive drug prescriptions and abnormal blood pressure (38.4%) had the higher prevalence than HSE. The use of diagnosis code or two abnormal blood pressure records within a 2-year period (31.1%) had similar prevalence and treatment rate of hypertension with HSE. ConclusionsDifferent definitions should be used for different study purposes. The definition of ‘diagnosis code or two abnormal blood pressure records with a 2-year period’ could be used for hypertension surveillance in THIN.

scholarly journals A Japan nationwide web-based survey of patient preference for renal denervation for hypertension treatment

2021 ◽  
Author(s):  
Kazuomi Kario ◽  
Hideaki Kagitani ◽  
Shoko Hayashi ◽  
Satsuki Hanamura ◽  
Keisuke Ozawa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Drug Therapy ◽  
Side Effects ◽  
Antihypertensive Drug ◽  
Patient Preference ◽  
Renal Denervation ◽  
Antihypertensive Drugs ◽  
Japanese Patients ◽  
Home Blood Pressure ◽  
Antihypertensive Drug Therapy

AbstractRenal denervation is a potential alternative to antihypertensive drug therapy. However, data on patient preference for this treatment option are limited and there are no data specifically from Asian patients. This study evaluated patient preference for renal denervation in patients with hypertension from Japan. Patients were a subset of those who participated in a March 2020 online electronic survey of patients with hypertension who had regularly visited medical institutions for treatment, were receiving antihypertensive drug therapy and had home blood pressure recordings available. The survey included a question about patient preference for treatment with renal denervation. A total of 2,392 patients were included (66% male, mean age 59.8 ± 11.6 years, mean duration of hypertension 11.4 ± 9.5 years). Preference for renal denervation was expressed by 755 patients (31.6%), and was higher in males than in females, in younger compared with older patients, in those with higher versus lower blood pressure, in patients who were less adherent versus more adherent to antihypertensive drug therapy, and in those who did rather than did not have antihypertensive drug-related side effects. Significant predictors of preference for renal denervation on logistic regression analysis were younger patient age, male sex, higher home or office systolic blood pressure, poor antihypertensive drug adherence, the presence of heart failure, and the presence of side effects during treatment with antihypertensive drugs. Overall, a relevant proportion of Japanese patients with hypertension expressed a preference for renal denervation. This should be taken into account when making shared decisions about antihypertensive drug therapy.

scholarly journals Drug utilization study of antihypertensive drugs and prevalence of blood pressure control in adult hypertensive patients based on JNC VIII guidelines in a tertiary care hospital: a cross sectional study

2019 ◽  
Vol 8 (2) ◽  
pp. 245
Author(s):  
Saumya Ramadas ◽  
M. B. Sujatha ◽  
M. A. Andrews ◽  
Sanalkumar K. B.
Keyword(s):  
Blood Pressure ◽  
Combination Therapy ◽  
Drug Utilization ◽  
Antihypertensive Drug ◽  
Blood Pressure Control ◽  
Antihypertensive Drugs ◽  
Pressure Control ◽  
Antihypertensive Drug Therapy ◽  
Care Hospital ◽  
Drug Utilization Study

Background: Hypertension is a major independent risk factor for coronary artery disease, congestive heart failure, stroke, chronic kidney disease and peripheral vascular diseases if left untreated. Drug utilization study of antihypertensive drugs and the study on prevalence of blood pressure control would help in reducing the burden of the disease and health expenditure.Methods: The study was conducted in the Outpatient Department of Medicine in Government Medical College, Thrissur. Patients aged 18yrs or above diagnosed with hypertension, on antihypertensive drugs were enrolled in the study. Patients suffering from secondary hypertension and acutely ill were excluded. Patients were enrolled after taking an informed consent. Demographic data, present treatment for hypertension, associated co- morbid conditions if any, and treatment of the same were recorded. BP was recorded, and cost of treatment was calculated using CIMS.Results: A total of 250 patients were included in the study. Mono therapy was used in 64.8% patients and combination therapy in 35.2%. Overall drug utilization pattern showed that CCBs (42.8%) were most commonly prescribed, followed by ACEIs (32.4%) and ARBs (29.2%). Most commonly prescribed combination therapy was ACE I + BB (29.3%), followed by ARB + CCB (21.3%). Mean cost of antihypertensive drug therapy was 3057.8 Rs / yr. Recommended target BP was achieved in 49.6% of patients.Conclusions: The prescription pattern of antihypertensive drug was in accordance to the JNC-VIII guidelines. The blood pressure target was achieved only in less than 50% of patients.

scholarly journals MANAGEMENT OF HYPERTENSION - AN AYURVEDIC REVIEW

2021 ◽  
Vol 9 (10) ◽  
pp. 2465-2471
Author(s):  
Garima Yadav ◽  
Pramod Kumar Mishra ◽  
Indu Sharma ◽  
Lekha Soni
Keyword(s):  
Blood Pressure ◽  
Dietary Habits ◽  
Antihypertensive Drugs ◽  
Medical Condition ◽  
Premature Death ◽  
Cost Effective ◽  
Systemic Blood Pressure ◽  
Arterial Disease ◽  
Treatment Modalities ◽  
Human Beings

Hypertension is the most common lifestyle disorder today. Systemic arterial hypertension is that the most important modifiable risk factor for all-cause morbidity and mortality. Worldwide one of the major causes of premature death is hypertension and can lead to major health consequences, such as CHD, CHF, peripheral arterial disease, stroke, renal failure, and death. Hypertension may be a chronic and sometimes asymptomatic medical condition during which systemic blood pressure is elevated beyond normal. Fewer than half of those with hypertension are conscious of their condition and lots of others are Modern treatment modalities are effective for the management of hypertension but pose human beings to their unwanted complications on their long-term use. The conventional antihypertensive drugs have many adverse effects & are not well tolerated which led to non-compliance, switching & discontinuation of treatment. There is no direct description of HTN in Ayurveda but based on its clinical presentation and similarity between pathogenesis factors for hypertension can be correlated with Raktagata Vata and it is considered as Tridoshaja Vyadhi. Treatment for hypertension in Ayurveda on the idea of Balancing all three Doshas. So Nidan Parivarajan, proper dietary habits, Yoga, Meditation along Ayurvedic herbs can be beneficial for balancing the state of mind, maintaining as well asreducing blood pressure. The Ayurvedic drug's potency depends upon rasa, Guna, Virya, Vipaka & Prabhava. Also, Acharyas have mentioned this as Prabhava of the drug. Ayurveda has various classical formulations and single herbs like Brahmi, Pushkarmoola, Jyotishamati, Sarpagandha, Saunf, Jatamansi etc. having Hridya, Kaphahara, Vatahara, Balya, Raktaprasadana, etc. properties which are safe and cost-effective too. Keywords: High Blood Pressure, Lifestyle disorders, Raktachapa, Silent killer.

Sex differences in antihypertensive drug use and blood pressure control

2019 ◽  
Vol 95 (1124) ◽  
pp. 295-299
Author(s):  
Junwen Wang ◽  
Weihong Jiang ◽  
Manju Sharma ◽  
Yuyan Wu ◽  
Jiayin Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sex Differences ◽  
Drug Use ◽  
Antihypertensive Drug ◽  
Antihypertensive Drugs ◽  
Age Groups ◽  
Channel Blockers ◽  
Elderly Age ◽  
Converting Enzyme Inhibitors ◽  
Males And Females

BackgroundHypertension is the most important modifiable cardiovascular risk factor. Epidemiological studies have shown the benefits of lowering blood pressure (BP), but BP control is a major challenge. Furthermore, there are significant sex differences in antihypertensive drug use and BP control. This study examined sex differences in antihypertensive drug use and BP control, with the aim of reducing the complications of hypertension and improving quality of life.MethodsThe study was performed in our outpatient hypertension clinic, and included 1529 patients without secondary hypertension or comorbidities. The study, investigated BP control rates and patterns of antihypertensive drug use in male and female. All data were collected using structured questionnaires and patient measurements.ResultsThe study included 713 males and 816 females in this study. Fewer females had hypertension in the younger age group (16.2% vs 11.6%; p>0.05), but this difference disappeared in middle-aged (47.8% vs 49.9 %; p<0.05) and elderly age groups (36.0% vs 38.5%; p<0.05). BP control rates differed between males and females (35.6% in male, 31.9% in female, p<0.01). There was an overall difference in BP control rates between males and females (35.6% in males, 31.9% in females, p<0.01). In this aged 18–44 years, angiotensin converting enzyme inhibitors (ACEIs) showed the best control rate in males, while calcium channel blockers (CCBs) were least effective (61.5% with ACEIs, 28.6% with CCBs; p<0.05). In this aged 45–64 years, diuretics (DUs) showed the best control rate in females, while CCBs were least effective (47.5% with DUs, 28.3% with CCBs; p<0.05).ConclusionsSex plays an important role in BP control. In those aged 18–44 years, males using ACEIs showed best control rates. In those aged 45–64 years, females using DUs showed best control rates. Our study provides a basis with the selection of antihypertensive drugs according to sex and age.

A comparative study of monotherapy versus combination therapy in patients with stage-1 hypertension in terms of efficacy and cost effectiveness and to assess the medication adherence

2018 ◽  
Vol 9 (1) ◽  
pp. 147 ◽  
Author(s):  
Ritu A Mathew ◽  
Samuel Johnson ◽  
Shalumol Jose ◽  
Shampa Chakraborty ◽  
Kenneth N ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Combination Therapy ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Financial Burden ◽  
Cost Effective ◽  
Dual Therapy ◽  
Individual Therapy ◽  
Stage 1

Hypertension has multiple pathogenesis and majority of patients require two or more antihypertensive drugs to provide optimum control of blood pressure. The aim is to compare the effectiveness of mono therapy versus combination therapy in patients with stage-1 hypertension, to assess the medication adherence and to compare the cost incurred per day for the different therapies. Patient’s demographical details and history was recorded in a data entry form. Outcome of the treatment was measured in terms of reduction in systolic and diastolic blood pressure. Patient’s medication adherence was assessed using modified Medication Adherence Scale. Economic outcomes were measured in terms of cost of individual therapy. The data was entered into the excel sheet and statistically analysed using ANOVA. Results showed that dual therapy is the most effective in reducing the mean systolic (28.75 mm Hg) and diastolic (8.875) blood pressure with the combination of Amlodipine + Telmisartan being the most effective. Here, 66 patients (33%) were found to be adherent and 134 patients (67%) were found to be non- adherent. It was found that AMLOKIND 2.5, LOSAKIND and ATEN 50 were the most cost effective brands of drug from the classes of calcium channel blockers, angiotensin receptor blockers and beta blockers respectively. Comparison of effectiveness of various antihypertensive therapies showed that dual therapy shows maximum reduction in mean systolic BP and thus it can be prescribed more often in Stage I hypertensive patients. The poor adherence scores indicate that a multidisciplinary approach with a greater involvement of the patient is required to increase the compliance of the patient. Also cost effective drugs need to be prescribed more in order to decrease the financial burden on the patients. Keywords: Blood pressure; Monotherapy; Dual therapy; Triple therapy; Medication adherence

Abstract 16061: Antihypertensive Therapy Prescribing Pattern Among Patients With Markedly Elevated Blood Pressure in a Real-world Setting

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yuan Lu ◽  
Chenxi Huang ◽  
Shiwani Mahajan ◽  
Cesar Caraballo ◽  
Erica S Spatz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Combination Therapy ◽  
Antihypertensive Drug ◽  
Guideline Adherence ◽  
Real World ◽  
Ace Inhibitor ◽  
Antihypertensive Drugs ◽  
Drug Prescription ◽  
Elevated Blood ◽  
Outpatient Visits

Introduction: Combination therapy with two or more antihypertensive agents is recommended for management of patients with markedly elevated blood pressure (systolic blood pressure [SBP] ≥160 mmHg or diastolic blood pressure [DBP] ≥100 mmHg) by the 2017 AHA/ACC hypertension guideline. Using electronic health records (EHR) data from a large health system, we characterized real-world antihypertensive drug prescribing patterns and assessed guideline adherence among ambulatory patients with markedly elevated BP. Methods: Our cohort included patients aged 18-85 years with at least 2 outpatient visits in the Yale New Haven Hospital System between January 1 st , 2013 and December 31 st , 2018, resulting in a total of 665,691 patients. We defined the phenotype of markedly elevated BP as two consecutive outpatient visits with SBP ≥160 mmHg or DBP ≥100 mmHg. We described the number and class of antihypertensive drugs (previously taken and newly prescribed) at the second visit with BP ≥160/100 mmHg. Results: We identified 38,098 patients with markedly elevated BP with a mean age of 62.4 (SD: 13.7) years; 47.9% were male; and 67.8%, 20.9%, and 9.3% were White, Black and Hispanic. Among them, 49.3% were not on any antihypertensive drugs at the end of the second visit, 26.2% had one active antihypertensive drug prescription, and 24.5% had two or more agents prescribed (Figure). Among patients with two or more antihypertensive drug prescriptions, the most common drug class combination prescribed was diuretic/ACE inhibitor (10.2%), followed by diuretic/ARB (9.3%), and ACE inhibitor/calcium channel blocker (6.5%). The low prescription of combination therapy was consistent across age, gender, and race subgroups. Conclusions: Prescribing of guideline-recommended combination antihypertensive drugs for patients with markedly elevated BP is suboptimal. Major opportunities exist for improving the guideline adherence of antihypertensive drug prescription in this population.

scholarly journals Blood pressure in hemodialysis patients during amelioration of anemia with erythropoietin.

1991 ◽  
Vol 2 (4) ◽  
pp. 927-936
Author(s):  
P A Abraham ◽  
M G Macres
Keyword(s):  
Blood Pressure ◽  
Drug Therapy ◽  
Diastolic Blood Pressure ◽  
Antihypertensive Drug ◽  
Antihypertensive Drugs ◽  
Pressure Control ◽  
Hemodialysis Patients ◽  
Uncontrolled Hypertension ◽  
Antihypertensive Drug Therapy ◽  
Dose Dependent

This study analyzed blood pressure in hemodialysis patients treated with epoetin beta in multicenter trials. Antihypertensive drugs were prescribed as usual. Placebo-controlled trials compared epoetin (100 to 150 U/kg; N = 151) with placebo (N = 78) for 82 days. Hemoglobin (108 +/- 18 versus 75 +/- 14 g/L) (mean +/- SD) and diastolic blood pressure (84 +/- 14 versus 78 +/- 15 mm Hg) were greater (P less than 0.05) after epoetin. Clinically important increases in blood pressure (increases in diastolic blood pressure greater than or equal to 10 mm Hg and/or drug therapy) were more frequent with epoetin (58 versus 37%; P = 0.005). A dose-response trial compared epoetin, 25 U/kg (N = 42), 100 U/kg (N = 40), and 200 U/kg (N = 39) for 138 days. Increases in hemoglobin were dose dependent, but clinically important increases in blood pressure were not. In analyses of all patients treated with epoetin (N = 272), no baseline or final level of hemoglobin, or rate of hemoglobin rise, was a threshold for a rise in blood pressure. Patients requiring antihypertensive drugs or having uncontrolled hypertension (diastolic blood pressure greater than 90 mm Hg) at baseline had decreases in blood pressure (P less than 0.05) with antihypertensive therapy. Thus, compared with placebo, 21% of patients had clinically important increases in blood pressure during amelioration of anemia. The baseline or final levels of hemoglobin, the extent or rate of hemoglobin rise, or uncontrolled hypertension or antihypertensive drug use at baseline were not confirmed as risks. Antihypertensive drug therapy was important for blood pressure control.

scholarly journals Comparative Effect of Antihypertensive Drugs in Improving Arterial Stiffness in Hypertensive Adults (RIGIPREV Study). A Protocol for Network Meta-Analysis

2021 ◽  
Vol 18 (24) ◽  
pp. 13353
Author(s):  
Iván Cavero-Redondo ◽  
Alicia Saz-Lara ◽  
Luis García-Ortiz ◽  
Cristina Lugones-Sánchez ◽  
Blanca Notario-Pacheco ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Antihypertensive Drug ◽  
Health Care Professionals ◽  
Antihypertensive Drugs ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Cochrane Database ◽  
Blood Pressure Treatment ◽  
Drug Interventions

(1) Background: Arterial stiffness is closely and bi-directionally related to hypertension and is understood as both a cause and a consequence of hypertension. Several studies suggest that antihypertensive drugs may reduce arterial stiffness. Therefore, effective prescription of antihypertensive drugs should consider both blood pressure and arterial stiffness. The aim of this protocol is to provide a review comparing the effects of different types of antihypertensive drug interventions on the reduction of arterial stiffness in hypertensive subjects. (2) Methods: The literature search will be performed through the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases. Randomised clinical trials assessing the effect of antihypertensive drug interventions on arterial stiffness measured in subjects with hypertension will be included. A frequentist network meta-analysis will be performed to determine the comparative effects of different antihypertensive drugs. (3) Results: The findings of this study will be published in a peer-reviewed journal. (4) Conclusions: This study will provide evidence for health care professionals on the efficacy of different antihypertensive drugs in decreasing arterial stiffness; in addition, it will analyse the efficacy of the drugs not only in terms of arterial stiffness but also in terms of blood pressure treatment.

scholarly journals Awareness, Treatment, and Control Rates of Hypertension in Adults Aged 35–75 Years in Three Provinces of Central China

2020 ◽  
Vol 33 (5) ◽  
pp. 471-471
Author(s):  
Jia-li Song ◽  
Jing-wei Yang ◽  
Dan-wei Zhang ◽  
Jian-lan Cui ◽  
Chao-qun Wu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Drug Use ◽  
Antihypertensive Drug ◽  
Mixed Model ◽  
Family Income ◽  
Antihypertensive Drugs ◽  
Individual Characteristics ◽  
Central China ◽  
Combination Drug ◽  
And Control

Abstract Background To describe the status of hypertension awareness, treatment, and control rates and their relationships with individual characteristics in Henan, Hubei, and Hunan provinces in central China, and to describe the patterns of antihypertensive drug use in this region. Methods The awareness, treatment, and control rates of hypertension in this area were identified through analysis of the data from China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project in three provinces (Henan, Hubei, and Hunan) of central China. The patterns of antihypertensive drug use were also examined. The mixed model was used to analyze the relationship between the awareness, treatment, and control rates and individual characteristics at the patient level. Results A total of 268,461 subjects were enrolled with 37.9% male and an average age of (56.3 ± 9.7) years. Among them, 129,099 (48.1%) had hypertension, of which 49.5% were aware of hypertension, 42.9% received antihypertensive drugs, and 11.5% had blood pressure under control. Calcium channel antagonists (54.6%) were the most widely used among all antihypertensive drugs. Of the patients whose blood pressure were not controlled, 25,482 patients (86.4%) took only one antihypertensive drug. In addition, the rate of awareness, treatment, and control of hypertension varied significantly among different populations: the rates were higher among the older, as well as among subjects with higher annual family income, higher educational status, and history of myocardial infarction, stroke, and diabetes (all P &lt; 0.05). Conclusions The awareness, treatment, and control rates of hypertension in adult patients of central China require further improvement. Meanwhile the proportion of combination drug therapy is low.

scholarly journals Management of renin-angiotensin-aldosterone inhibitors and other antihypertensives and their clinical effects on pre-anesthesia blood pressure

2022 ◽  
Author(s):  
Eda Balcı ◽  
Zeliha Aslı Demir ◽  
Melike Bahçecitapar
Keyword(s):  
Blood Pressure ◽  
Drug Treatment ◽  
Systolic Blood Pressure ◽  
Antihypertensive Drug ◽  
Antihypertensive Drugs ◽  
Treatment Strategies ◽  
Clinical Effects ◽  
Renin Angiotensin ◽  
Perioperative Morbidity ◽  
Antihypertensive Drug Treatment

Background: Blood pressure fluctuations appear more significant in patients with poorly controlled hypertension and are known to be associated with adverse perioperative morbidity. In the present study, we aimed to determine the effects of antihypertensive drug treatment strategies on preanesthetic operating room blood pressure measurements.Methods: A total of 717 patients participated in our study; 383 patients who were normotensive based on baseline measurements and not under antihypertensive therapy were excluded from the analysis. The remaining 334 patients were divided into six groups according to the antihypertensive drug treatment. These six groups were examined in terms of preoperative baseline and pre-anesthesia blood pressure measurements. Results: As a result of the study, it was observed that 24% of patients had high blood pressure precluding surgery, and patients using renin-angiotensin-aldosterone system inhibitors (RAASI) had higher pre-anesthesia systolic blood pressure than patients using other antihypertensive drugs. Patients who received beta-blockers were also observed to have the lowest pre-anesthesia systolic blood pressure, diastolic blood pressure, and mean blood pressure, compared to others. Conclusions: Recently, whether RAASI should be continued preoperatively remains controversial. Our study shows that RAASI cannot provide optimal pre-anesthesia blood pressure and lead to an increase in the number of postponed surgeries, probably due to withdrawal of medication before the operation. Therefore, the preoperative discontinuation of RAASI should be reevaluated in future studies.

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