ASSESSMENT OF THE SITUATION OF USE OF BLOOD PRESSURED DRUGS IN THE TREATMENT OF HIGH BLOOD PRESSURE FOR OUTCOME PATIENTS AT NAM DINH PROVINCIAL HOSPITAL IN JANUARY 2021

2021 ◽  
Vol 62 (6) ◽  
Author(s):  
Nguyen Thi Khanh ◽  
Nguyen Thi Tuyet Duong
Keyword(s):  
Ace Inhibitors ◽  
Antihypertensive Effect ◽  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Cross Sectional ◽  
Calcium Blockers ◽  
Common Combination ◽  
Selection Of

Hypertension is a disease that seriously affects the health and life expectancy of the community, playing a major etiological role in target organ damage. The selection of antihypertensive drugs to ensure reasonable safety and effectiveness is always a matter of concern of the medical industry. Applying the cross-sectional method on 2,640 patients being examined and treated for hypertension at Nam Dinh general hospital, it was found that 54.67% female patients accounted for the majority. The age of disease in both sexes is over 50 years old with a relatively high frequency of comorbidities. Most of them were prescribed drug combinations in treatment 77,9%. The group of ACE inhibitors + calcium blockers is the most common combination. ACE inhibitors are also the most commonly prescribed drugs in monotherapy. 11,4% of cases had adverse drug interactions, the most dangerous combination is UCMC + Potassium chloride and UCMC + Spironolactone causing hypokalemia. The most common interaction between beta-blockers and calcium blockers increases the antihypertensive effect.

scholarly journals Validation of the optical Aktiia bracelet in different body positions for the persistent monitoring of blood pressure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Josep Sola ◽  
Anna Vybornova ◽  
Sibylle Fallet ◽  
Erietta Polychronopoulou ◽  
Arlene Wurzner-Ghajarzadeh ◽  
...  
Keyword(s):  
Antihypertensive Drugs ◽  
Target Organ Damage ◽  
Real Life ◽  
Organ Damage ◽  
Standing Position ◽  
Health Interventions ◽  
Wearable Device ◽  
Cross Sectional ◽  
Candidate Solution ◽  
Diagnosis Of Hypertension

AbstractThe diagnosis of hypertension and the adjustment of antihypertensive drugs are evolving from isolated measurements performed at the physician offices to the full phenotyping of patients in real-life conditions. Indeed, the strongest predictor of cardiovascular risk comes from night measurements. The aim of this study was to demonstrate that a wearable device (the Aktiia Bracelet) can accurately estimate BP in the most common body positions of daily life and thus become a candidate solution for the BP phenotyping of patients. We recruited 91 patients with BP ranging from low to hypertensive levels and compared BP values from the Aktiia Bracelet against auscultatory reference values for 4 weeks according to an extended ISO 81060-2 protocol. After initializing on day one, the observed means and standard deviations of differences for systolic BP were of 0.46 ± 7.75 mmHg in the sitting position, − 2.44 ± 10.15 mmHg in the lying, − 3.02 ± 6.10 mmHg in the sitting with the device on the lap, and − 0.62 ± 12.51 mmHg in the standing position. Differences for diastolic BP readings were respectively of 0.39 ± 6.86 mmHg, − 1.93 ± 7.65 mmHg, − 4.22 ± 6.56 mmHg and − 4.85 ± 9.11 mmHg. This study demonstrates that a wearable device can accurately estimate BP in the most common body positions compared to auscultation, although precision varies across positions. While wearable persistent BP monitors have the potential to facilitate the identification of individual BP phenotypes at scale, their prognostic value for cardiovascular events and its association with target organ damage will need cross-sectional and longitudinal studies. Deploying this technology at a community level may be also useful to drive public health interventions against the epidemy of hypertension.

scholarly journals Resistant hypertension: Prevalence and profile of patients followed in a university ambulatory

2021 ◽  
Vol 9 ◽  
pp. 205031212110208
Author(s):  
Ana Flávia Moura ◽  
José A Moura-Neto ◽  
Cibele Isaac Saad Rodrigues ◽  
Mariana O Miranda ◽  
Tulio Coelho Carvalho ◽  
...  
Keyword(s):  
Outpatient Clinic ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Channel Blockers ◽  
Angiotensin Ii Receptor ◽  
Hypertensive Patients ◽  
Increased Risk

Background: Hypertension affects about 36 million Brazilians. It is estimated that 10%–20% of these have resistant hypertension. These patients are at an increased risk of early target organ damage, as well as cardiovascular and renal events. Objective: To estimate the prevalence of resistant hypertension in a specialized outpatient clinic, to describe the sociodemographic and clinical characteristics of these patients, and to identify possible factors associated with resistant hypertension. Methods: Data collection from medical records of hypertensive patients treated using oral antihypertensive drugs in optimized doses at a specialized university clinic from March 2014 to December 2014, after ethical approval statement. All patients were using appropriate antihypertensive drugs in optimized doses and assisted at a teaching-assistance clinic of internal medicine of the Bahiana School of Medicine and Public Health in Brazil. Results: A total of 104 patients were enrolled and 31.7% (n = 33) had criteria for resistant hypertension. Of the total participants, 75.7% were female and 54.8% were black or brown. The average age was 61.7 years (SD ± 10.1). In the resistant hypertension group, 63.6% had diabetes, compared to 32.4% in the hypertension group. Among resistant hypertensive patients, 51.5% had dyslipidemia. Regarding drug treatment, 75.8% of the resistant hypertension group and 51.4% of the hypertension group used statins. Among patients with resistant hypertension, 90.9% used angiotensin II receptor blockers and 66.7%, dihydropyridine calcium channel blockers. In the resistant hypertension group, 75.8% used beta-blockers, against 25.4% in the hypertension group. Conclusion: The prevalence of hypertension was higher than that described in the global literature, which may be associated with the high percentage of black and brown (“pardos”) patients in the population studied, and also because the study was performed in a specialized outpatient clinic.

scholarly journals Rational pharmacotherapy of hypertension. Urapidil potential

2013 ◽  
Vol 10 (4) ◽  
pp. 38-43
Author(s):  
T E Morozova ◽  
T B Andruschishina ◽  
D G Shmarova
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Effect ◽  
Antihypertensive Drugs ◽  
Combined Therapy ◽  
Evidence Base ◽  
Uncontrolled Hypertension ◽  
5Ht1a Receptor ◽  
Reflex Tachycardia ◽  
The Central Nervous System ◽  
Selection Of

Optimizing pharmacotherapy of arterial hypertension (AH) and varied selection of medicines remains an urgent problem for practitioners. However, despite the large variety of effective antihypertensive drugs, the control of blood pressure levels remains inadequate. Most patients require combined therapy with two or more agents to achieve target blood pressure levels, so the choice of second-line therapy is of particular importance. As adjunctive therapy in patients with uncontrolled hypertension a-blockerscan be used, which, in addition to the antihypertensive effect, have a number of other benefits including improved lipid profile and glucose metabolism, as well as reducing the symptoms of benign prostatic hyperplasia. Urapidil provides a-blocking effect and additionally exhibits the central sympatholytic effect which is mediated by stimulation of serotonin 5HT1A-receptor in the central nervous system. The evidence base suggests that the drug has antihypertensive effect in combination with a favorable metabolic profile, and has a good safety profile as well, and has no disadvantages inherent to a-blockers, in particular, the development of reflex tachycardia.

scholarly journals Effects of inhibition of the renin-angiotensin system on hypertension-induced target organ damage: clinical and experimental evidence

2021 ◽  
Vol 91 (1) ◽  
Author(s):  
Maria Rosaria De Luca ◽  
Daniela Sorriento ◽  
Domenico Massa ◽  
Valeria Valente ◽  
Federica De Luise ◽  
...  
Keyword(s):  
Angiotensin Ii ◽  
Ace Inhibitors ◽  
Ventricular Hypertrophy ◽  
Target Organ Damage ◽  
Renin Angiotensin System ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Angiotensin System ◽  
Hypertensive Patients

The dysregulation of renin-angiotensin-system (RAS) plays a pivotal role in hypertension and in the development of the related target organ damage (TOD). The main goal of treating hypertension is represented by the long-term reduction of cardiovascular (CV) risk. RAS inhibition either by angiotensin converting enzyme (ACE)-inhibitors or by type 1 Angiotensin II receptors blockers (ARBs), reduce the incidence of CV events in hypertensive patients. Actually, ACE-inhibitors and ARBs have been demonstrated to be effective to prevent, or delay TOD like left ventricular hypertrophy, chronic kidney disease, and atherosclerosis. The beneficial effects of RAS blockers on clinical outcome of hypertensive patients are due to the key role of angiotensin II in the pathogenesis of TOD. In particular, Angiotensin II through an inflammatory-mediated mechanism plays a role in the initiation, progression and vulnerability of atherosclerotic plaque. In addition, Angiotensin II can be considered the hormonal transductor of the pressure overload in cardiac myocytes, and through an autocrine-paracrine mechanism plays a role in the development of left ventricular hypertrophy. Angiotensin II by modulating the redox status and the immune system participates to the development of chronic kidney disease. The RAS blocker should be considered the first therapeutic option in patients with hypertension, even if ACE-inhibitors and ARBs have different impact on CV prevention. ARBs seem to have greater neuro-protective effects, while ACE-inhibitors have greater cardio-protective action.

scholarly journals The Role of Renin-Angiotensin System in Prothrombotic State in Essential Hypertension

2010 ◽  
pp. 13-23 ◽  
Author(s):  
A Remková ◽  
M Remko
Keyword(s):  
Essential Hypertension ◽  
Ace Inhibitors ◽  
Target Organ Damage ◽  
Renin Angiotensin System ◽  
Organ Damage ◽  
Angiotensin Ii Receptor ◽  
Prothrombotic State ◽  
Atherosclerotic Vascular Disease ◽  
Increased Risk ◽  
Receptor Blockers

Rheological, haemostatic, endothelial and platelet abnormalities appear to play a role in the thrombotic complications of hypertension. This prothrombotic/hypercoagulable state in hypertension may contribute to the increased risk and severity of target organ damage. It can be induced by the activated reninangiotensin system (RAS), with abnormalities in endothelial and platelet function, coagulation and fibrinolysis. Treatment of uncomplicated essential hypertension by RAS targeting antihypertensive therapy could result in a reversal of prothrombotic abnormalities, contributing to a reduction of thrombosis-related complications. Since angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have two distinct mechanisms of RAS interruption, it is hypothesized that each therapy might have different impact on the prothrombotic state in hypertensive patients. Some studies demonstrate a beneficial effect of both ACE inhibitors and ARBs on prothrombotic state, in addition to their efficacy to normalize elevated blood pressure. The potentially antithrombotic effect of the RAS inhibiting agents may in turn support the preservation of cardiovascular function. Available data may offer an additional explanation for the efficacy of the RAS targeting agents in the prevention of cardiovascular events in patients with atherosclerotic vascular disease.

scholarly journals Pattern of use of biologics in psoriasis among Indian dermatologists – A cross sectional survey

2021 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Shekhar Neema ◽  
Disha Dabbas ◽  
S. Radhakrishnan ◽  
Arun Kumar Yadav
Keyword(s):  
Small Sample Size ◽  
Target Organ Damage ◽  
Group Discussion ◽  
Organ Damage ◽  
Small Sample ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Major Factors ◽  
Prohibitive Cost ◽  
The Cost

Background and Aims: Biologics are a relatively new class of highly effective drugs in the management of psoriasis. They act on specific immune processes, achieve rapid and sustained clearance and do not cause target organ damage unlike conventional systemic therapy. It appears that their use in our country is not as widespread as in developed nations despite these benefits ; their prohibitive cost may be a major factor for the limited usage. This survey aimed to find out the extent of use and factors hindering usage of biologics for the management of psoriasis by Indian dermatologists. Methods: It was a cross-sectional questionnaire based study. The questionnaire was designed after a focussed group discussion, followed by validation. The survey was sent in the form of a link to Indian dermatologists. The responses were recorded in excel-sheet and the data was analyzed by SPSS ver 25. Results: Of the 310 participants who took part, 287 completed the survey. Two hundred (70%) were users of biologics, while 87 (30%) had never used them. Cost was the major factor which prevented biologic use. Majority of the respondents used biologics in less than 2 cases per month. Secukinumab was the most common biologic used followed by etanercept. The factors which determined choice of biologics were convenience, cost, previous experience, co-morbid conditions and recommendations by an expert. Limitations: A small sample size was the limitation of the study. Dermatologists who do not use biologics may be under-represented in the study. Conclusions: Biologics are not used optimally by Indian dermatologists for management of psoriasis. The cost, fear of adverse effects, lack of awareness and inadequate felt need are major factors which prevent their regular use.

scholarly journals PHARMACOEPIDEMIOLOGY OF USING OF ANTIHYPERTENSIVE DRUGS BY FAMILY PHYSICIANS

2020 ◽  
pp. 94-99
Author(s):  
B. G. Khojakuliev ◽  
O. A. Orazgylyjov ◽  
T. Khojageldiev ◽  
M. K. Kurdova
Keyword(s):  
Blood Pressure ◽  
Calcium Antagonists ◽  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Reduce Blood Pressure ◽  
Outpatient Basis ◽  
Family Doctors ◽  
Rational Use ◽  
Adrenergic Blockers ◽  
Selection Of

The purpose of the study: to study the features of the rational use of antihypertensive drugs (AHP) by family doctors on an outpatient basis and their analysis of compliance with current international recommendations.Materials and methods: According to questionnaires specially developed for studying the pharmacoepidemiology of hypertension, interviews were conducted with family doctors working in health houses located in different regions of the country and the specifics of their appointment of hypertension to patients with hypertension were studied. The duration of medical experience of doctors is on average 22.6 ± 11.0 years.Results: The main drugs in the prescription structure were ACE inhibitors (19.7%), beta-blockers (19.6%), calcium antagonists (19.1%, diuretics (18.9%) ARBs (12.8%). central action drugs – 8.5%, alpha-adrenergic blockers – 1.4%. ACE inhibitor administration structure: enalapril – 33.8%, lisinopril – 26.3%, captopril – 23.3%, perindopril – 10.1 %, ramipril – 4.7%, the rest - 1.3% Of the beta-blockers: atenolol – 35.7%, bisoprolol – 34.7%, propranolol -15.7%, metoprolol - 8.0%, nebivolol – 4.3% and carvedilol 1.7%. The structure of the appointment of calcium antagonists: amlodipine – 38,3%, nifedipine – 29.6%, verapamil 16.8%, nifedipine SR and verapamil SR 5.7% each, diltheazem 2.1%, the share of all the others no more than 1.8%. Diuretic structure: hydrochlorothiazide – 36.0 %, furosemide – 28.8%, spironolactone – 18.6%, indapamide – 13.5%, torasemide – 2.1%, acetazolamide – 0.9%. The main proportion of ARB was losartan (84.0%) valsartan (8.7%), candesartan (4.2%), all the rest – 3.1%. 38.1% of family doctors still prescribe a centrally acting drug – clofellin, an imidazoline receptor agonist moxonidine (physiotens) is prescribed by family doctors very rarely (1.8%).73.2% of respondents seek to reduce blood pressure to 140/90 mm Hg. Art., and the rest are limited to lowering blood pressure to a «working» level. 33.7% of family doctors start hypertension with monotherapy with the selection of an effective dose of one drug. 40.6% of doctors prefer free combination of AHP, 54.7% consider fixed combinations to be convenient, the rest are low-dose combinations.Conclusion: Our study confirms the need for further improvement of the rational use of AHP by family doctors

scholarly journals Empagliflozin for Patients With Presumed Resistant Hypertension: A Post Hoc Analysis of the EMPA-REG OUTCOME Trial

2020 ◽  
Author(s):  
João Pedro Ferreira ◽  
David Fitchett ◽  
Anne Pernille Ofstad ◽  
Bettina Johanna Kraus ◽  
Christoph Wanner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Repeated Measures ◽  
Cox Regression ◽  
Antihypertensive Drugs ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Cardiac Events ◽  
Post Hoc Analysis ◽  
Post Hoc

Abstract BACKGROUND Type 2 diabetes (T2D) and resistant hypertension often coexist, greatly increasing risk of target-organ damage and death. We explored the effects of empagliflozin in patients with and without presumed resistant hypertension (prHT) in a post hoc analysis of EMPA-REG OUTCOME (NCT01131676). METHODS Overall, 7,020 patients received empagliflozin 10, 25 mg, or placebo with median follow-up of 3.1 years. We defined baseline prHT as ≥3 classes of antihypertensive drugs including a diuretic and uncontrolled blood pressure (BP; systolic blood pressure (SBP) ≥140 and/or diastolic blood pressure ≥90 mm Hg) or ≥4 classes of antihypertensive, including a diuretic, and controlled BP. We explored the effect of empagliflozin on cardiovascular (CV) death, heart failure (HF) hospitalization, 3-point major adverse cardiac events, all-cause death, and incident/worsening nephropathy by Cox regression and BP over time by a mixed-repeated-measures-model analysis. RESULTS 1,579 (22.5%) patients had prHT. The mean difference in change in SBP from baseline to week 12 vs. placebo was −4.5 (95% confidence interval, −5.9 to −3.1) mm Hg (P < 0.001) in prHT and −3.7 (−4.5, −2.9) mm Hg (P < 0.001) in patients without prHT. SBP was more frequently controlled (<130/80 mm Hg) with empagliflozin than with placebo. Patients with prHT had 1.5- to 2-fold greater risk of HF hospitalization, incident/worsening nephropathy, and CV death compared with those without prHT. Empagliflozin improved all outcomes in patients with and without prHT (interaction P > 0.1 for all outcomes). CONCLUSIONS Empagliflozin induced a clinically relevant reduction in SBP and consistently improved all outcomes regardless of prHT status. Due to these dual effects, empagliflozin should be considered for patients with hypertension and T2D.

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