scholarly journals Antihypertensive Medication Use and Its Effects on Blood Pressure and Haemodynamics in a Tri-ethnic Population Cohort: Southall and Brent Revisited (SABRE)

2022 ◽  
Vol 8 ◽  
Author(s):  
Alun D. Hughes ◽  
Sophie V. Eastwood ◽  
Therese Tillin ◽  
Nish Chaturvedi
Keyword(s):  
Structural Equation ◽  
Antihypertensive Medication ◽  
Structural Equation Models ◽  
Arterial Compliance ◽  
Medication Use ◽  
Antihypertensive Agents ◽  
Study Data ◽  
Antihypertensive Medications ◽  
African Caribbean ◽  
Treatment Effect Models

Objectives:We characterised differences in BP control and use of antihypertensive medications in European (EA), South Asian (SA) and African-Caribbean (AC) people with hypertension and investigated the potential role of type 2 diabetes (T2DM), reduced arterial compliance (Ca), and antihypertensive medication use in any differences.Methods:Analysis was restricted to individuals with hypertension [age range 59–85 years; N = 852 (EA = 328, SA = 356, and AC =168)]. Questionnaires, anthropometry, BP measurements, echocardiography, and fasting blood assays were performed. BP control was classified according to UK guidelines operating at the time of the study. Data were analysed using generalised structural equation models, multivariable regression and treatment effect models.Results:SA and AC people were more likely to receive treatment for high BP and received a greater average number of antihypertensive agents, but despite this a smaller proportion of SA and AC achieved control of BP to target [age and sex adjusted odds ratio (95% confidence interval) = 0.52 (0.38, 0.72) and 0.64 (0.43, 0.96), respectively]. Differences in BP control were partially attenuated by controlling for the higher prevalence of T2DM and reduced Ca in SA and AC. There was little difference in choice of antihypertensive agent by ethnicity and no evidence that differences in efficacy of antihypertensive regimens contributed to ethnic differences in BP control.Conclusions:T2DM and more adverse arterial stiffness are important factors in the poorer BP control in SA and AC people. More effort is required to achieve better control of BP, particularly in UK ethnic minorities.

scholarly journals The longitudinal association between the use of antihypertensive medications and 24-hour sleep in nursing homes: results from the randomized controlled COSMOS trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elisabeth Flo-Groeneboom ◽  
Tony Elvegaard ◽  
Christine Gulla ◽  
Bettina S Husebo
Keyword(s):  
Blood Pressure ◽  
Nursing Home ◽  
Antihypertensive Medication ◽  
Sleep Problems ◽  
Medication Use ◽  
Control Group ◽  
Antihypertensive Medications ◽  
Randomized Controlled ◽  
Nursing Home Patients ◽  
Longitudinal Association

Abstract Background Antihypertensive medication use and sleep problems are highly prevalent in nursing home patients. While it is hypothesized that blood pressure and antihypertensive medication use can affect sleep, this has not been investigated in depth in this population. Alongside a multicomponent intervention including a systematic medication review, we aimed to investigate the longitudinal association between antihypertensive medication use, blood pressure and day- and night-time sleep over 4 months. Methods This study was based on secondary analyses from the multicomponent cluster randomized controlled COSMOS trial, in which the acronym denotes the intervention: COmmuncation, Systematic pain assessment and treatment, Medication review, Organization of activities and Safety. We included baseline and 4-month follow-up data from a subgroup of nursing home patients who wore actigraphs (n = 107). The subgroup had different levels of blood pressure, from low (< 120) to high (≥ 141). Assessments included blood pressure, antihypertensive medication use, and sleep parameters as assessed by actigraphy. Results We found a significant reduction in total sleep time at month four in the intervention group compared to the control group. When analysing the control group alone, we found a significant association between antihypertensive medication use and increased daytime sleep. We also found negative associations between blood pressure, antihypertensive medication use and sleep onset latency in the control group. Conclusions Our results suggest a correlation between excessive daytime sleep and antihypertensive medication use. These findings should be followed up with further research, and with clinical caution, as antihypertensive medications are frequently used in nursing homes, and sleep problems may be especially detrimental for this population. Trial registration The trial is registered at clinicaltrials.gov (NCT02238652).

scholarly journals The Association between Antihypertensive Medication Use and Blood Pressure Is Influenced by Obesity

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Jash S. Parikh ◽  
Arshdeep K. Randhawa ◽  
Sean Wharton ◽  
Heather Edgell ◽  
Jennifer L. Kuk
Keyword(s):  
Blood Pressure ◽  
Ace Inhibitors ◽  
Antihypertensive Medication ◽  
Medication Use ◽  
Normal Weight ◽  
Antihypertensive Medications ◽  
Glucose Levels ◽  
Health And Nutrition ◽  
Obesity Status ◽  
Main Effects

Introduction. One in three US adults is living with obesity or hypertension, and more than 75% of hypertensive individuals are using antihypertensive medications. Therefore, it is important to examine blood pressure (BP) differences in populations that are using these medications with differing obesity status. Aim. We examined whether BP attained when using various antihypertensive medications varies amongst different body mass index (BMI) categories and whether antihypertensive medication use is associated with differences in other metabolic risk factors, independent of BMI. Methods. Adults with hypertension from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 were used (n=15,285). Linear regression analyses were used to examine the main effects and interaction between antihypertensive use and BMI. Results. In general, users of antihypertensive medications had lower BP than those not taking BP medications (NoBPMed) (P<0.05), whereby in women, the differences in systolic BP between angiotensin-converting-enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) users and NoBPMed were greater in those with obesity (ACE inhibitors: −14 ± 1 mmHg; ARB: −16 ± 1 mmHg) compared to normal weight individuals (ACE inhibitors: −9 ± 1 mmHg; ARB: −11 ± 1 mmHg) (P<0.05). Diastolic BP differences between women ARB users and NoBPMed were also greatest in obesity (−5 ± 1 mmHg) (P<0.05) whilst there were no differences in normal weight individuals (−1 ± 1 mmHg) (P>0.05). Furthermore, glucose levels and waist circumference in women were higher in those using ACE inhibitors compared to diuretics (P<0.05). Conclusion. ACE inhibitors and ARBs may be associated with more beneficial BP profiles in women with obesity, with no obesity-related BP differences for antihypertensive medication in men. However, there could be potential cardiometabolic effects for some antihypertensive medications that should be explored further.

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.

Abstract P378: Current Progress of Antihypertensive Medication Use According to Healthy People 2020 Goals Among Adults With Hypertension- the National Health Interview Survey 2014-2015

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Jing Fang ◽  
Carma Ayala ◽  
Fleetwood Loustalot
Keyword(s):  
Health Care ◽  
National Health ◽  
National Health Interview Survey ◽  
Antihypertensive Medication ◽  
Medication Use ◽  
Healthy People ◽  
Antihypertensive Medications ◽  
Health Interview Survey ◽  
Interview Survey ◽  
Healthy People 2020

Background: Hypertension is a major risk factor for heart disease and stroke; yet only half of those with hypertension have it under control. One of the Healthy People 2020 goals is to increase the proportion of adults with hypertension who are taking antihypertensive medications to lower their blood pressure from a baseline of 63.2% to a target of 69.5% by 2020. The objective of this study was to examine progress towards meeting this national objective and to assess disparities mid-decade. Methods: Adult participants (≥18 years) with self-reported hypertension from the National Health Interview Survey in 2014 and 2015 were included in this study. Current antihypertensive medication use was assessed and age-standardized for analysis. Multivariable logistic regression models were used to determine the odds ratio of antihypertensive medication use, adjusting for age, sex, race/ethnicity, education and health care access status. Results: Among the 21,050 (26.7%) adults with self-reported hypertension, 69.2% reported current antihypertensive medication use and disparities were noted among subgroups. Adults with estimates of antihypertensive medication use that fell below the Healthy People 2020 goal (69.5%) included women, non-Hispanic whites, Hispanics, and those with access health care barriers (Table). Conclusion: To control hypertension, most patients require antihypertensive medications to achieve control. Understanding disparities in antihypertensive medication utilization is needed for all population to achieve Healthy People 2020 targets by the end of the decade.

scholarly journals Changes in Blood Pressure Levels and Antihypertensive Medication Use before and after Renal Transplantation among Patients in Nairobi, Kenya: A Comparative Cross-Sectional Study

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Mary N. Kubo ◽  
Joshua K. Kayima ◽  
Anthony J. Were ◽  
Mohammed S. Ezzi ◽  
Seth O. McLigeyo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Transplantation ◽  
Antihypertensive Medication ◽  
Medication Use ◽  
Cross Sectional Study ◽  
Renal Transplant Recipients ◽  
Sectional Study ◽  
Antihypertensive Medications ◽  
Cross Sectional ◽  
Before And After

Objectives.To determine the changes in blood pressure levels and antihypertensive medication use in the postrenal transplantation period compared to pretransplantation one.Methods. A comparative cross-sectional study was carried out on renal transplant recipients at the Kenyatta National Hospital, a national referral hospital in Kenya. Sociodemographic details, blood pressure levels, and antihypertensive medication use before and after renal transplantation were noted. Changes in mean blood pressure levels and mean number of antihypertensive medications after renal transplantation were determined using pairedt-test.Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male : female ratio of 1.9 : 1. Compared to the pretransplant period, significantly lower mean systolic and diastolic blood pressure levels after transplantation were noted (mean SBP 144.5 mmHg versus 131.8 mmHg; mean DBP 103.6 mmHg versus 83.5 mmHg in the pre- and posttransplant periods, respectively,p<0.001). Mean number of antihypertensive medications also reduced significantly after transplantation, with an average of 3.3 (±1.6) versus 2.1 (±0.9) in the pre- and posttransplant periods, respectively (p<0.001).Conclusion. There is a significant reduction in blood pressure levels and number of antihypertensive medications used after renal transplantation. The positive impact of renal transplantation on blood pressure control should be confirmed using prospective cohort studies of patients with end stage renal disease who then undergo renal transplantation.

Long-Term Hemodynamic Effects After Carotid Artery Revascularization

2019 ◽  
Vol 53 (4) ◽  
pp. 297-302
Author(s):  
Sungho Lim ◽  
Michael J. Javorski ◽  
Sean P. Nassoiy ◽  
Yaeji Park ◽  
Pegge M. Halandras ◽  
...  
Keyword(s):  
Heart Rate ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Antihypertensive Medication ◽  
Tertiary Care ◽  
Antihypertensive Agents ◽  
Long Term Effects ◽  
Medication Regimen ◽  
Antihypertensive Medications

Objective: The baroreceptor at the carotid body plays an important role in hemodynamic autoregulation. Manipulation of the baroreceptor during carotid endarterectomy (CEA) or radial force from carotid artery angioplasty and/or stenting (CAS) may cause both intraoperative and postoperative hemodynamic instability. The purpose of this study is to evaluate the long-term effects of CEA and CAS on blood pressure (BP), heart rate (HR), and subsequent changes on antihypertensive medications. Methods: A retrospective chart review was performed to identify patients who underwent CEA or CAS between 2009 and 2015 at a single tertiary care institution. Baseline demographics and comorbidities were recorded. Operative details of the carotid artery endarterectomy and the use of balloon angioplasty during the CAS were analyzed. Hemodynamic parameters such as BP, HR, and antihypertensive medication requirement were evaluated at 3, 6, 12, 24, and 36 months. Results: A total of 289 patients were identified. The average age was 70.6 years old, and males constituted 64.0%. All patients had moderate (>50%) to severe (>70%) carotid stenosis. Of those, 111 (40.5%) patients were symptomatic. Systolic BP (mm Hg) of CAS and CEA were similar over the entire follow-up period. Heart rate (beats/min) remained stable postoperatively. A reduced number of antihypertensive medications was observed in the CAS cohort during the first postoperative year when compared to the preoperative baseline: 2.03 at preop, 1.77 ( P < .01) at 3 months, 1.78 ( P = .02) at 6 months, 1.77 ( P = .02) at 12 months, 1.86 ( P = .09) at 24 months, and 2.03 ( P = =.50) at 36 months. Logistic regression analysis identified that CAS (odds ratio [OR]: 2.52, confidence interval [CI]: 1.09-5.83) and multiple (>2) antihypertensive medication use at baseline (OR: 5.89, CI: 2.62-13.26) were predictors for a reduction in the number of antihypertensive medications following carotid revascularization. Conclusion: Surgical intervention for carotid stenosis poses a risk of postoperative hemodynamic dysregulation. Although postoperative BP and HR remained relatively stable after both CAS and CEA, the number of postoperative antihypertensive medications was reduced in the CAS cohort for the first postoperative year when compared to baseline. Patients with multiple antihypertensive agents undergoing CAS should have close postoperative BP monitoring and should be monitored for a possible reduction in their antihypertensive medication regimen.

Association between office blood pressure, antihypertensive medication use and male sexual dysfunction: a penile Doppler study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Ioakeimidis ◽  
K Rokkas ◽  
D Terentes-Printzios ◽  
A Angelis ◽  
I Dima ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Medication ◽  
Antihypertensive Drugs ◽  
Medication Use ◽  
Peak Systolic Velocity ◽  
Fold Increase ◽  
Hypertension Status ◽  
Antihypertensive Medications ◽  
Doppler Study ◽  
Arterial Insufficiency

Abstract Background Arterial hypertension is associated with an almost two-fold increase in the likelihood of having an abnormal penile blood flow. Recent evidence supports the independent of age and blood pressure (BP) level predictive value of severe penile arterial insufficiency for adverse cardiovascular events. Purpose Aim of this study is to quantify the association between BP level and severity of penile vascular disease and to examine the potential for differences in effect of BP lowering medication use on the associations between BP level and penile vascular damage. Methods We measured penile peak systolic velocity (PSV) in 356 consecutive men with erectile dysfunction (ED) and without a history of diabetes and cardiovascular disease; The cohort was divided according to office systolic BP (SBP) and diastolic BP in three BP categories: normal (SBP &lt;130 and DBP &lt;85 mmHg, n=117), high normal (130≤SBP&lt;140 or DBP 85≤DBP&lt;90mmHg, n=91), and hypertension (SBP≥140 or DBP≥90mmHg, n=148). 164 (46%) patients of the whole study population were treated with antihypertensive medications. Low PSV values after intracavernous injection of prostanglandin E1 indicate impaired penile blood inflow and severe vasculogenic ED. Results Figure shows PSV measurements of the three office BP categories subdivided according to use of antihypertensive therapy. Treated and untreated hypertensive patients had similar mean PSV. Interestingly, the mean PSV of men with high normal BP not receiving antihypertensive drugs was significantly higher compared to PSV of men with high normal BP under therapy and significantly lower compared to PSV of normotensive males without therapy (all P&lt;0.05). Among males not receiving antihypertensive medications there was a progressive decrease in PSV values from normal BP, to high normal BP and to hypertension (P=0.01, after adjustment for age), while among males under antihypertension therapy, the three BP categories had similar PSV level (P=0.54 after adjustment for age) (figure). Conclusion The inverse associations observed between hypertension status and penile arterial insufficiency in men not taking antihypertensive medication were attenuated or disappeared among men reporting antihypertensive medication use reflecting a medication effect or structural effects of longstanding hypertension on the penile vasculature. BP level, hypertension therapy and PSV Funding Acknowledgement Type of funding source: None

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.

Measuring the Big Five in Self-Report and Other Ratings

2000 ◽  
Vol 16 (1) ◽  
pp. 31-43 ◽  
Author(s):  
Claudio Barbaranelli ◽  
Gian Vittorio Caprara
Keyword(s):  
Big Five ◽  
Structural Equation ◽  
Structural Equation Models ◽  
Error Variance ◽  
The Self ◽  
Self Report ◽  
Sources Of Information ◽  
Third Person ◽  
Fit Indexes ◽  
Response Modes

Summary: The aim of the study is to assess the construct validity of two different measures of the Big Five, matching two “response modes” (phrase-questionnaire and list of adjectives) and two sources of information or raters (self-report and other ratings). Two-hundred subjects, equally divided in males and females, were administered the self-report versions of the Big Five Questionnaire (BFQ) and the Big Five Observer (BFO), a list of bipolar pairs of adjectives ( Caprara, Barbaranelli, & Borgogni, 1993 , 1994 ). Every subject was rated by six acquaintances, then aggregated by means of the same instruments used for the self-report, but worded in a third-person format. The multitrait-multimethod matrix derived from these measures was then analyzed via Structural Equation Models according to the criteria proposed by Widaman (1985) , Marsh (1989) , and Bagozzi (1994) . In particular, four different models were compared. While the global fit indexes of the models were only moderate, convergent and discriminant validities were clearly supported, and method and error variance were moderate or low.

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