SCOPE AND NEED OF COMBINATION OF ANTIHYPERTENSIVE DRUGS

INDIAN DRUGS ◽  
2012 ◽  
Vol 49 (05) ◽  
pp. 5-19
Author(s):  
S. R Pattan ◽  
◽  
A. O. Zanwar ◽  
N. B Wabale ◽  
U. B. Shetkar
Keyword(s):  
Blood Pressure ◽  
Ace Inhibitors ◽  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Blood Pressure Reduction ◽  
Pressure Control ◽  
Channel Blockers ◽  
Once Daily ◽  
First Line Therapy ◽  
Dose Combination

The recommendation for first-line therapy for hypertension remains a beta blocker or diuretic given in a low dosage. A target blood pressure of less than 140/90 mm Hg is achieved in about 50 percent of patients treated with monotherapy; two or more agents from different pharmacological classes are often needed to achieve adequate blood pressure control. Single-dose combination antihypertension therapyis an important option that combines efficacy of blood pressure reduction and a low side effect profilewith convenient once-daily dosing to enhance compliance. Combination antihypertensives include combined agents from the following pharmacological classes: diuretics and potassium-sparing diuretics,beta blockers and diuretics, angiotensin-converting enzyme (ACE) inhibitors and diuretics, angiotensin-II antagonists and diuretics and calcium channel blockers and ACE inhibitors.

Abstract P297: Comparing Blood Pressure Control in Diabetic verses Non-Diabetic Veterans following Percutaneous Coronary Intervention (PCI)

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Sloane A McGraw ◽  
Michael Scholfield ◽  
Ragu Murthy ◽  
Anupama Shivaraju ◽  
Burhan Mohamedali ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Pressure Control ◽  
Joint National Committee ◽  
National Committee ◽  
Diabetic Patients ◽  
Channel Blockers ◽  
The Mean ◽  
Artery Disease

Background: Blood pressure (BP) control in patients with coronary artery disease (CAD) is beneficial on morbidity and mortality, however the US Joint National Committee VII (JNC-7) also recommends systolic BP (SBP) <130 and diastolic BP (DBP) <80 for diabetic patients because diabetes itself is an additional risk for a cardiac event. This can be attained using beta-blockers (BB), angiotensin agonists (ACE-I/ARB), calcium channel blockers, diuretics and nitrates. Methods: We conducted a retrospective cohort study focusing on attaining JNC-7 guidelines, comparing outcomes between 302 diabetic to the 469 non-diabetic patients; all underwent PCI between September 2004 and September 2008 at the Jesse Brown Veterans Hospital in Chicago, IL. We collected data of BP values and antihypertensive regimens on admission and at six month follow up, and correlated these into percentages of which have attained goals. Results: Among diabetics, mean SBP decreased from 134 to 130mmHg (p = 0.002) and mean DBP decreased from 72 to 70mmHg (p= 0.004); in the non-diabetics, the mean SBP decreased from 133 to 127mmHg (p<0.0001) and the mean DBP decreased from 73 to 71mmHg (p<0.0012). With regards to guidelines, the percent of diabetics at SBP goal increased from 41% to 51% (124 to 154 of 302) (p= 0.006), however the percent at DBP goal was not significant. In non-diabetics, percent at goal for SBP increased 46% to 57% (216 to 267 of 469) (p=0.0002) and for DBP increased 69% to 76% (324 to 356 of 469) (p=0.0131). At 6 months, among diabetics the medication usage increased with BB, 80% to 92% (241 to 278 of 302) (p<0.0001) and nitrates 30% to 36% (91 to 109 of 302) (p=0.035). Similarly, among non-diabetics, use of BB, 68% to 87% (319 to 408 of 469) (p<0.0001) and nitrates 19% to 24% (89 to 113 of 469) (p=0.006) increased, as well as ACE-I/ARB 52% to 71% (244 to 333 if 469) (p<0.0001). Conclusions: There were improvements in BP among both populations at six months post-PCI; both attained JNC-7 SBP goal, but only non-diabetics achieved DBP goal. Medication use increased for both groups with BB and nitrates, but also with ACE-I/ARB for non-diabetics only. This analysis suggests that tighter control needs to be obtained among diabetics, especially because they are a higher risk population than those solely with CAD.

scholarly journals Hypertension approach in patients with chronic kidney disease

Medic ro ◽  
2018 ◽  
Vol 125 (5) (1) ◽  
pp. 40-45
Author(s):  
Mihaela Daniela Baltă
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ace Inhibitors ◽  
Cardiovascular Events ◽  
Pressure Control ◽  
Channel Blockers ◽  
Major Cardiovascular Events ◽  
Disease Rates ◽  
Risk Of Progression

Most patients with chronic kidney disease (CKD) have hypertension, and CKD is characterized by high and very high cardiovascular disease rates. Hypertension is an important cardiovascular risk factor, and its treatment prevents major cardiovascular events and lowers mortality of all causes and especially cardiovascular mortality. Therefore antihypertensive therapy is part of the management of chronic kidney disease. Effective blood pressure control decreases not only the risk of fatal and non-fatal cardiovascular events, but also reduces the rate of progression of renal impairment. Target bloodline values are not definitively established, but most guidelines recommend lowering systolic blood pressure to values below 140-130 mmHg, depending on the presence of proteinuria. Additional studies are needed to establish the blood pressure (BP) target, especially for patients with GFR below 45 ml/min./1.73 m2, where the benefits of too aggressive BP may be outweighed by the risk of progression to renal insufficiency. Most patients with chronic kidney disease require therapy with two or three therapeutic agents, the most commonly used drugs being ACE inhibitors/ARB (if there is intolerance to ACE inhibitors), calcium channel blockers and diuretics.

scholarly journals What do we Mean by “Ideal” Blood Pressure Control?

Kardiologiia ◽  
2021 ◽  
Vol 61 (7) ◽  
pp. 68-78
Author(s):  
O. D. Ostroumova ◽  
A. I. Kochetkov ◽  
N. A. Arablincky ◽  
N. A. Shatalova ◽  
R. R. Romanovsky ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
Real Life ◽  
Cognitive Disorders ◽  
Pressure Control ◽  
Fixed Dose ◽  
Cerebrovascular Complications ◽  
Dose Combination ◽  
Numerous Data ◽  
Cognitive Disorders And Dementia

Arterial hypertension (AH) is one of the most important risk factors for development of myocardial infarction, chronic heart failure, stroke, cognitive disorders and dementia, and chronic kidney disease. Currently, special attention is paid to increased blood pressure variability (BPV) as a new risk factor for development of cardiovascular and cerebrovascular complications. The available evidence-based body of clinical studies demonstrates the importance of reducing not only the blood pressure itself but also the increased BPV to provide significant improvement of the prognosis and limits the risk of complications. This notion has been validated in consensus documents on the management of patients with AH. Among antihypertensive drugs, the fixed-dose combination (FC) amlodipine/perindopril has demonstrated a unique capability for reducing all types of BPV (visit-to-visit, day-to-day, during 24 h). According to current clinical guidelines, this combination belongs to first-line FCs indicated for most patients with AH. A distinctive feature of the FC amlodipine/perindopril is numerous data from real-life clinical practice, which support both its high antihypertensive efficacy and the ability to decrease high BPV. Therefore, the FC amlodipine/perindopril can be recommended for a broad range of AH patients to achieve BP control and to improve the prognosis.

Abstract 159: Comparing Blood Pressure Control in Diabetic vs Non-Diabetic Veterans following Percutaneous Coronary Intervention

2013 ◽  
Vol 33 (suppl_1) ◽  
Author(s):  
Dmitry Blumenkrants ◽  
Saifullah M Siddiqui ◽  
Karthik Challa ◽  
Amit Ladani ◽  
Adhir Shroff
Keyword(s):  
Blood Pressure ◽  
Lifestyle Modification ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Pressure Control ◽  
National Committee ◽  
Diabetic Patients ◽  
Channel Blockers ◽  
Antihypertensive Medications ◽  
The Mean

Background As per the US Joint National Committee VII (JNC-7) recommendations, patients with known underlying coronary artery disease and diabetes should have goal blood pressures (BP) of systolic (SBP) <130 and diastolic (DBP) <80 to decrease morbidity and mortality associated with cardiovascular disease. In addition to lifestyle modification, these goals can be attained by use of 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 the attainment of the JNC-7 guidelines, comparing outcomes between 415 diabetic to 637 non-diabetic patients undergoing PCI between September 2004 and December 2012 at the Jesse Brown Veterans Administration Hospital in Chicago, IL. Blood pressure (BP) measurements and antihypertensive medications pre and post PCI at 6-month follow-up were documented. Results Among the diabetic population, the mean SBP decreased from 136 to 131 mmHg (p < 0.0001) and mean DBP decreased from 73 to 70 mmHg (p < 0.0001). In the non-diabetics, the mean SBP decreased from 133 to 127 mmHg (p < 0.0001) and the mean DBP decreased from 74 to 71 mmHg (p < 0.0001). With regards to JNC-7 guidelines, the percent of diabetics at SBP goal increased from 42% to 49% (p = 0.047) and percent at DBP goal increased from 74% to 82% (p = 0.008). In non-diabetics, percent at goal for SBP increased from 46% to 57% (p < 0.0001) and percent at DBP goal increased from 68% to 76% (p = 0.003). Among diabetics, there was a statistically significant (p <0.0001) increase in use of BB from 77% to 90%. In non-diabetics, there was a statistically significant (p <0.0001) increase in use of BB from 64% to 86% and ACE-I/ARB from 51% to 70%. Conclusions In both groups (diabetics and non-diabetics) undergoing PCI, both systolic and diastolic blood pressure improved with more patients achieving JNC-7 targets. Among diabetics, there was a significant increase in utilization of BB. Among non-diabetics, there was a significant increase in utilization of BB and ACE-I/ARB.

Abstract 253: Blood Pressure Control at 6 Months After Percutaneous Coronary Intervention at a Veterans Hospital

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Saifullah M Siddiqui ◽  
Dmitry Blumenkrants ◽  
Karthik Challa ◽  
Amit Ladani ◽  
Adhir Shroff
Keyword(s):  
Blood Pressure ◽  
Percutaneous Coronary Intervention ◽  
Beta Blockers ◽  
Coronary Intervention ◽  
Pressure Control ◽  
Joint National Committee ◽  
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), nitrates and diuretics. Methods: We conducted a retrospective cohort study focusing on the achievement of JNC-7 recommended BP goals in a diverse population of 1052 veterans undergoing Percutaneous Coronary Intervention (PCI) between September 2004 and December 2011 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 1052 patients studied, the mean SBP decreased from 134 mm Hg to 128 mm Hg, and the mean DBP decreased from 73 mm Hg to 70 mm Hg. In regards to the JNC-7 guidelines, the percent of patients who achieved SBP goals increased from 44% (462 of 1052) to 54% (567 of 1050), and the percent of patients who achieved DBP goals increased from 71% (747 of 1052) to 78% (819 of 1050). There was a statistically significant increase in the use of ACE-I/ARB from 61% (645 of 1050) to 74% (776 of 1046), BB from 69% (723 of 1050) to 87% (912 of 1047), and nitrates from 23% (244 of 1050) to 28% (289 of 1046). The use of diuretics increased from 40% 422 of 1050) to 41% (426 of 1047), which was not statistically significant. There was a decrease in the use of CCB from 32% (332 of 1050) to 28% (293 of 1044), which was also not statistically significant. Conclusion: There was improvement in both mean BP and percentage of patients achieving JNC-7 recommended goals for SBP and DBP at six months post PCI, although overall percentages still remain suboptimal. Additionally, medication use improved in most drug classes. Beta-blocker, angiotensin antagonist as well as nitrate use increased significantly. Use of calcium channels blockers, which have no proven mortality benefit in this cohort, decreased, however this was not statistically significantly. Data was collected comparing both BP measurements and anti-hypertensive regimens pre- and post- PCI.

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.

scholarly journals Cost-effectiveness of hypertension treatment: a population-based study

2002 ◽  
Vol 120 (4) ◽  
pp. 100-104 ◽  
Author(s):  
Juvenal Soares Dias da Costa ◽  
Sandra Costa Fuchs ◽  
Maria Teresa Anselmo Olinto ◽  
Denise Petrucci Gigante ◽  
Ana Maria Baptista Menezes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cost Effectiveness ◽  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Population Based ◽  
Channel Blockers ◽  
Hypertension Treatment ◽  
Population Based Study ◽  
Treatment Of Hypertension ◽  
The Cost

CONTEXT: The cost-effectiveness of the treatment of hypertension has scarcely been investigated in population-based studies. Most data come from secondary analysis of clinical trials and administrative sources. OBJECTIVE: To describe the healthcare costs for outpatient hypertension treatment in comparison with diabetes mellitus and chronic bronchitis, and to examine the cost-effectiveness of different classes of antihypertensive drugs. DESIGN: Cross-sectional population-based study. SETTING: Urban area of Pelotas, southern Brazil. PARTICIPANTS: Individuals aged 20-69 years, identified through multi-stage probability sampling. METHODS: Participants were interviewed at home. Demographic data, education, income, smoking, previous morbidity, use of medicine and other characteristics were assessed via a pre-tested questionnaire, and blood pressure while seated was measured in a standardized way. RESULTS: Approximately 24% of the participants had high blood pressure or were taking antihypertensive drugs, and among these, 33% had had a physician consultation during the month preceding the interview. The monthly mean costs of care for hypertension (R$ 89.90), diabetes (R$ 80.64) and bronchitis (R$ 92.63) were similar. Treatment of hypertension consumed 22.9% of the per-capita income, corresponding to R$ 392.76 spent per year exclusively on antihypertensive drugs. Most of the direct costs associated with hypertension and diabetes were spent on drugs, while patients with bronchitis had greater expenditure on appointments. The cost-effectiveness relationship was more favorable for diuretics (116.3) and beta blockers (228.5) than for ACE inhibitors (608.5) or calcium channel blockers (762.0). CONCLUSION: The costs of hypertension care are mainly dependent on the expenditure on blood pressure-lowering drugs. Treatment of hypertension with diuretics or beta blockers was more cost-effective than treatment with ACE inhibitors and calcium channel blockers.

Long-term antihypertensive treatment improves ventricular-arterial interaction in hypertensive patients: a 3-year follow-up study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Ikonomidis ◽  
S Tzortzis ◽  
H Triantafyllidi ◽  
J Thymis ◽  
A Frogoudaki ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ace Inhibitors ◽  
Vascular Function ◽  
Antihypertensive Treatment ◽  
Global Longitudinal Strain ◽  
Pressure Control ◽  
Channel Blockers ◽  
Longitudinal Deformation ◽  
Flow Reserve

Abstract Background We investigated the effects of antihypertensive treatment on vascular function, longitudinal deformation and ventricular-arterial interaction in hypertensives. Methods In 200 untreated patients with arterial hypertension (age 52.5±11.6 years, 56% females), we measured at baseline and after a 3-year of antihypertensive treatment (160 received ACEi± diuretics and 40 CCBs± diuretics): a) 24h ambulatory blood pressure b) Carotid-femoral pulse wave velocity (PWV) b) Coronary flow reserve (CFR), LV mass index (LVMI), the global longitudinal strain (GLS). We calculated the ratio of PWV/GLS (-m/sec%) reflecting the ventricular-arterial interaction. Results Compared to baseline, there was an improvement of GLS (−19.9±3.4 vs. −18.7±3.1%), post-treatment. In parallel, there were improvement in CFR (2.72±0.61 vs. 2.55±0.64), PWV (10.3±1.9 vs. 11.2±2.1 m/s), LVMI and PWV/GLS (−0.539±0.146 vs. −0.618±0.178 -m/sec%) (p&lt;0.01 for all comparisons). By multivariate analysis, the reduction of 24h meanBP as well as PWV independently determined the respective improvement of GLS (b=0.478, b=0.248, respectively, p&lt;0.001). By ANOVA, the interaction term between changes of all the above parameters and antihypertensive treatment (ACE inhibitors vs calcium channel blockers) was not significant (p&gt;0.05). Conclusions Long-term optimal blood pressure control with ACE inhibitors and CCBs improves LV longitudinal deformation along with reduction of arterial stiffness, leading to improved ventricular-arterial interaction in hypertensives. Funding Acknowledgement Type of funding source: None

scholarly journals Evoluzione storica della farmacoutilizzazione degli anti-ipertensivi in Italia (1988-1998)

2003 ◽  
Vol 4 (1S) ◽  
pp. 35-44 ◽  
Author(s):  
Enrico Bologna ◽  
Pierluigi Russo ◽  
Sabrina Licata ◽  
Liliana Civalleri ◽  
Luciano Caprino
Keyword(s):  
Ace Inhibitors ◽  
Treatment Guidelines ◽  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Pharmaceutical Expenditure ◽  
Annual Number ◽  
Channel Blockers ◽  
Anatomic Therapeutic Chemical ◽  
Drug Classes ◽  
Defined Daily Doses

The aim of this study was to perform an historical evaluation of pharmacoutilization of main antihypertensive drug classes in Italy between 1988 and 1998. There were analysed numbers of packs and costs for diuretics, beta-blockers, central and peripheral antihypertensive drugs (CPAD), calcium-channel blockers (CCB), angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II (AII) receptor antagonists. The amount of defined-daily-doses (DDDs) per preparation was calculated by dividing the annual number of packs by respective DDD value. The number of DDDs was grouped according to the second level of the anatomic-therapeutic-chemical (ATC) classification. The amount of annual expenditures for each ATC level was converted to current monetary values. To calculate the annual cost per DDD, the expenditure was divided by respective number of DDDs. From 1988 to 1998, total number of DDDs of antihypertensive drugs grew from 193.657.092 to 396.140.967 with an increase of 105%, while the expenditure grew from 40.886.385 to 126.102.362, with an increase of 208%. Comparing data of 1990 and 1998, the DDDs of antihypertensive drugs increased of about 79%, the expenditure for these drugs increased of about 115%, while the global pharmaceutical expenditure increased only of 34%. Taking each drug class separately, CCB and ACE-inhibitors are the classes with the higher number of DDDs and the higher expenditure; while alpha-receptor blockers, ACE-inhibitors and AII- antagonists are the classes with the higher cost per DDD. In conclusion this study describes a substantial modification of pharmacoutilization of antihypertensive drugs in Italy along a ten-years span. The agreement between utilization trends and indications of international treatment guidelines, as well as the economic impact on drugs expenditure have been discussed.

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