scholarly journals Blood Pressure Control and Antihypertensive Treatment Among Hemodialysis Patients—Retrospective Single Center Experience

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 590
Author(s):  
Piotr Skonieczny ◽  
Zbigniew Heleniak ◽  
Marek Karowiec ◽  
Stanisław Zajączkowski ◽  
Leszek Tylicki ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Calcium Channel ◽  
Blood Pressure Control ◽  
Calcium Channel Blockers ◽  
Antihypertensive Treatment ◽  
Pressure Control ◽  
Hemodialysis Patients ◽  
Channel Blockers ◽  
Renin Angiotensin Aldosterone System ◽  
The Mean

Background and Objectives: Hypertension affects at least 80% of hemodialysis patients. Inappropriate control of blood pressure is mentioned as one of the essential cardiovascular risk factors associated with development of cardiovascular events in dialysis populations. The aim of the cross-sectional, retrospective study was the evaluation of the antihypertensive treatment schedule and control of blood pressure in relation to the guidelines in the group of hemodialysis patients. Additionally, we assessed the level of decrease in blood pressure by each group of hypotensive agents. Materials and Methods: 222 patients hemodialyzed in a single Dialysis Unit in three distinct periods of time—2006, 2011, and 2016—with a diagnosis of hypertension were enrolled in the study. The analysis of the antihypertensive treatment was based on the medical files and it consisted of a comparison of the mean blood pressure results reported during the six consecutive hemodialysis sessions. Results: The mean values of blood pressure before hemodialysis were as follows: 134/77, 130/74, and 140/76 mmHg, after hemodialysis 124/74, 126/73, and 139/77 mmHg in 2006, 2011, and 2016 respectively. The goal of predialysis blood pressure control (<140/90) was achieved by up to 64.3% of participants in 2006 as compared to 49.4% in 2016. Additionally, the postdialysis goal (<130/90) reached 57.1% of the study population in 2006 as compared to 27.1% of patients in 2016. The differences in percentage of patients using single, double, triple, and multidrug therapy during observation were not statistically significant. The most often used drugs were ß-blockers, diuretics, and calcium channel blockers in all points of the study. Blockades of the renin–angiotensin–aldosterone system in 2006 and calcium channel blockers in 2011 and 2016 were the drugs with highest impact on lowering blood pressure. Conclusions: The goal of predialysis or postdialysis blood pressure control was achieved in a lower percentage of patients during the period of the study. Blockade of renin–angiotensin–aldosterone system and calcium channel blockers decrease the blood pressure significantly. It is necessary to achieve better control of blood pressure in prevention of cardiovascular incidents.

scholarly journals Treating patients with hypertension in Indonesia’s primary health care centre: A challenging condition

2019 ◽  
Vol 2019 (2) ◽  
Author(s):  
Lucky Aziza Abdullah Bawazir ◽  
Wicensius Sianipar
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Primary Health Care ◽  
Calcium Channel ◽  
Blood Pressure Control ◽  
Calcium Channel Blockers ◽  
Antihypertensive Agents ◽  
Pressure Control ◽  
Channel Blockers ◽  
Primary Health

Background: In Indonesia, hypertension treatment relies on primary health care services, and there are no current data on blood pressure control and hypertension treatment in Indonesia’s primary health care system.Methods: We conducted a cross-sectional study including all patients with hypertension (n = 273) who visited the Tegal Alur II Community Health Center in 2017. For all patients with hypertension, medical records containing the most recent blood pressure results and antihypertensive treatments were examined by the authors. The primary outcome in this study was optimal blood pressure control according to the Joint National Committee (JNC) VII guidelines.Results: The mean systolic and diastolic blood pressures were 143.7 mmHg (SD 18.5) and 87 mmHg (SD 11.4), respectively. Calcium channel blockers were the most frequently used antihypertensive agents (58.6%). Of all patients with hypertension, 27.1% achieved controlled blood pressure. Bivariate analysis revealed a significant association between antihypertensive agents and blood pressure control (p = 0.009). Multivariate analysis showed that calcium channel blockers were the strongest predictor of blood pressure control, with an adjusted odds ratio of 1.9 (95% confidence interval [CI] 1.1–3.5, p= 0.022).Conclusion: Controlled blood pressure was achieved by less than half of all patients with hypertension visiting the Tegal Alur II Community Health Center in 2017. The majority of patients with hypertension received single-drug therapy with calcium channel blockers, the most frequently used antihypertensive agents. There was a significant association between antihypertensive agents and blood pressure control.Funding: This study received no financial support from any specific funding agencies.

scholarly journals Renoprotective effect of calcium channel blockers

2009 ◽  
Vol 137 (11-12) ◽  
pp. 690-696
Author(s):  
Nada Dimkovic ◽  
Sinisa Dimkovic
Keyword(s):  
Blood Pressure ◽  
Renal Failure ◽  
Calcium Channel ◽  
Blood Pressure Control ◽  
Calcium Channel Blockers ◽  
Ace Inhibitors ◽  
Clinical Studies ◽  
Pressure Control ◽  
Channel Blockers ◽  
Glomerular Arterioles

The advancing chronic renal failure is at most the consequence of secondary haemodynamic and metabolic factors as intraglomerular hypertension and glomerular hypertrophy. Although tight blood pressure control is the major preventive mechanism for progressive renal failure, ACE inhibitors and angiotensin receptor blockers have some other renoprotective mechanisms beyond the blood pressure control. That is why these two groups of antihypertensive drugs traditionally have advantages in treating renal patients especially those with proteinuria over 400-1000 mg/day. Even if earlier experimental studies have shown renoprotective effect of calcium channel blockers, later clinical studies did not prove that calcium channel blockers have any advantages in renal protection over ACE inhibitors given as monotherapy or in combination with ACE inhibitors. It was explained by action of calcium channel blockers on afferent but not on efferent glomerular arterioles; a well known mechanism that leads to intraglomerular hypertension. New generations of dihydropiridine calcium channel blockers can dilate even efferent arterioles not causing unfavorable haemodynamic disturbances. This finding was confirmed in clinical studies which showed that renoprotection established by calcium channel blockers was not inferior to that of ACE inhibitors and that calcium channel blockers and ACE inhibitors have additive effect on renoprotection. Newer generation of dihydropiridine calcium channel blockers seem to offer more therapeutic possibilities in renoprotection by their dual action on afferent and efferent glomerular arterioles and, possibly by other effects beyond the blood pressure control.

Abstract P140: Blood Pressure Control in Veterans Following Percutaneous Coronary Intervention (PCI)

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Sloane A McGraw ◽  
Michael Scholfield ◽  
Ragu Murthy ◽  
Burhan Mohamedali ◽  
Anupama Shivaraju ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Pressure Control ◽  
Joint National Committee ◽  
National Committee ◽  
Channel Blockers ◽  
Drug Classes

Background: Control of blood pressure (BP) in patients with underlying coronary artery disease (CAD) provides a decreased risk in morbidity and mortality. According to the US Joint National Committee VII (JNC-7) recommendations, patients with underlying CAD should have goal blood pressures of systolic <130 and diastolic <80. These goals can be attained by using multiple classes of drugs including beta-blockers (BB), angiotensin agonists (ACE-I/ARB), calcium channel blockers (CCB), diuretics and nitrates. Methods: We conducted a retrospective cohort study focusing on attaining JNC-7 guidelines for BP in a diverse population of 772 patients undergoing PCI between September 2004 and September 2008 at the Jesse Brown Veterans Hospital in Chicago, IL. Data was collected which compared both BP measurements and antihypertensive regimens pre and post PCI. Results: For the 772 patients, the overall population mean systolic blood pressure (SBP) decreased from 134 to 128mmHg (p < 0.0001) and mean diastolic blood pressure (DBP) decreased from 73 to 70mmHg (p < 0.0001). With regards to JNC-7 guidelines, the percent of patients who reached SBP goals increased from 44 to 54% (340 to 417 of 772) (p < 0.0001) and with DBP goals rose from 72 to 78% (556 to 602 of 772) (p = 0.0031). At 6 months, there was a statistically significant (all p values <0.0001) change in the use of each drug class; the use of ACE-I/ARB increased from 64% (494 out of 772) to 76% (587 of 772) and BB from 73% (564 of 772) to 89% (687 of 772). There was also increased utilization of diuretics 41% (317 of 772) to 43% (332 of 772) and nitrates 23% (178 of 772) to 29% (224 of 772), however a decrease in the use of calcium channel blockers, 34% (262 of 772) to 31% (239 of 772). Conclusions: There was improvement in BP in the six months after PCI and although there were higher rates of attainment of JNC-7 goals for SBP and DBP at six months, overall percentage values are still suboptimal. Additionally, the medication usage improved in most drug classes with exception of calcium channel blockers; however these increases still leave some room for improvement.

Abstract P166: Blood Pressure Control Following Percutaneous Coronary Intervention at a VA Hospital

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Chris Healy ◽  
Sloane A McGraw ◽  
Burhan Mohamedali ◽  
Anupama Shivaraju ◽  
Michael Scholfield ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Percutaneous Coronary Intervention ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
National Committee ◽  
Channel Blockers ◽  
Percutaneous Coronary ◽  
The Mean

Background: Blood pressure (BP) control in patients with coronary artery disease (CAD) decreases morbidity and mortality. The US Joint National Committee VII (JNC-7) recommends patients with underlying CAD have a goal systolic blood pressure (SBP) < 130 and a diastolic blood pressure (DBP) < 80. These goals can be achieved by using multiple classes of drugs, including beta-blockers (BB), angiotensin antagonists (ACE-I/ARB), calcium channel blockers (CCB), diuretics, and nitrates. Methods: We conducted a retrospective cohort study focusing on the attainment of JNC-7 recommended BP goals in a diverse population of 857 veterans undergoing Percutaneous Coronary Intervention (PCI) between September 2004 and December 2009 at the Jesse Brown Veterans Hospital in Chicago, IL. Data was collected comparing both BP measurements and anti-hypertensive regimens pre and post PCI. Results: In the 857 patients studied, the mean SBP decreased from 134 mm Hg to 129 mm Hg (p<0.0001), and the mean DBP decreased from 73 mm Hg to 71 mm Hg (p<0.0001). In regards to the JNC-7 guidelines, the percent of patients who achieved SBP goals increased from 44% to 54% (377 to 463 of 857) (p<0.0001), and the percent of patients who achieved DBP goals increased from 71% to 78% (608 to 668 of 857) (p<0.0001). There was a change in the use of each drug class; the use of ACE-I/ARB increased from 72% to 89% (617 to 763 out of 857) (p<0.0001), the use of BB increased from 63% to 76% (540 to 651 out of 857) (p<0.0001), the use of diuretics increased from 41% to 43% (351 to 369 out of 857) (p=0.2997), and the use nitrates increased from 24% to 29% (206 to 249 out of 857) (p=0.0007). The use of CCB, however, decreased from 34% to 30% (291 to 257 out of 857) (p=0.0121). Conclusions: There was improvement in both mean BP and percentage of patients achieving JNC-7 recommended goals for SBP & DBP at six months post PCI, though overall percentages still remain suboptimal. Additionally, medication use improved in most drug classes, with the exception of calcium channel blockers. In particular, both beta-blocker and angiotensin antagonist use increased significantly.

Effort blood pressure control in the course of antihypertensive treatment

1989 ◽  
Vol 87 (3) ◽  
pp. S46-S56 ◽  
Author(s):  
Oreste De Divitiis ◽  
Salvatore Di Somma ◽  
Vincenzo Liguori ◽  
Maurizio Petitto ◽  
Carmine Magnotta ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Antihypertensive Treatment ◽  
Pressure Control
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