To provide updated, evidence-based recommendations for the therapy of hypertension in adults.
For patients with hypertension, a number of antihypertensive agents may control blood pressure. Randomized trials evaluating first-line therapy with thiazides, beta-adrenergic antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, alpha-blockers, centrally acting agents or angiotensin II receptor antagonists were reviewed.
The health outcomes that were considered were changes in blood pressure, cardiovascular morbidity, and cardiovascular and/or all-cause mortality rates. Economic outcomes were not considered due to insufficient evidence.
MEDLINE was searched for the period March 1999 to October 2001 to identify studies not included in the 2000 revision of the Canadian Recommendations for the Management of Hypertension. Reference lists were scanned, experts were polled, and the personal files of the subgroup members and authors were used to identify other published studies. All relevant articles were reviewed and appraised, using prespecified levels of evidence, by content experts and methodological experts.
A high value was placed on the avoidance of cardiovascular morbidity and mortality.
Various antihypertensive agents reduce the blood pressure of patients with sustained hypertension. In certain settings, and for specific classes of drugs, blood-pressure lowering has been associated with reduced cardiovascular morbidity and/or mortality.
The present document contains detailed recommendations pertaining to treatment thresholds, target blood pressures, and choice of agents in various settings in patients with hypertension. The main changes from the 2000 Recommendations are the addition of a section on the treatment of hypertension in patients with diabetes mellitus, the amalgamation of the previous sections on treatment of hypertension in the young and old into one section, increased emphasis on the role of combination therapies over repeated trials of single agents and expansion of the section on the treatment of hypertension after stroke. Implicit in the recommendations for therapy is the principle that treatment for an individual patient should take into consideration global cardiovascular risk, the presence and/or absence of target organ damage, and comorbidities.
All recommendations were graded according to strength of the evidence and voted on by the Canadian Hypertension Recommendations Working Group. Individuals with potential conflicts of interest relative to any specific recommendation were excluded from voting on that recommendation. Only those recommendations achieving high levels of consensus are reported here. These guidelines will continue to be updated annually.
BACKGROUND: In an elderly, community based population we aimed at investigating antihypertensive and lipid lowering medication use in relation to own and familiar cardiovascular morbidity and diabetes mellitus, as well as to lifestyle factors and general health. We also examined levels of blood pressure in untreated and treated residents, to investigate factors correlating with blood pressure control. METHODS: A health survey carried out in 1997-9 in the county of Hordaland, Norway included a self-administered questionnaire mailed to 4,338 persons born in 1925-7. Drug use the day prior to filling in the questionnaire was reported. A health check-up was carried out, where their systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), and serum-cholesterol level were recorded. RESULTS: One third of respondents used one or more antihypertensive drugs, while 13% of men and women were treated with a statin. Diabetes mellitus, own or relatives'cardiovascular disease, having quit smoking, physical inactivity, and overweight correlated with antihypertensive treatment. Mean blood pressure was lower in respondents not on treatment. Among those on treatment, 38% of men and 29% of women had reached a target BP-level of lower than 140/90 mm Hg. Own cardiovascular disease and a low BMI correlated with good BP-control. CONCLUSION: One third of 70-74 year old individuals living in the community used one or more antihypertensive drugs. Only around one third of those treated had reached a target BP-level of less than 140/90 mm Hg. Own cardiovascular disease and a low BMI correlated with good BP-control.
The benefits of continuous treatment of hypertension have been extensively documented in randomized controlled trials. However, clinical trials may not reflect actual drug use in the population.
To examine the distribution and determinants of patterns of use of antihypertensive agents in the first 5 years of hypertension treatment in Saskatchewan.
Patterns of use and modifications to therapy were derived from a careful examination of medication use in a cohort of 19 501 subjects aged 40 to 79 years, without recognized cardiac disease and initiating therapy with an angiotensin-converting enzyme inhibitor, a calcium antagonist, or a beta-blocker in Saskatchewan between 1990 and 1993.
Angiotensin-converting enzyme inhibitors (37.4%), followed by calcium antagonists (27.5%) and beta-blockers (26.4%), were the most commonly prescribed agents to initiate treatment in our study population. Patients with diabetes were less likely to be dispensed a beta-blocker, as were younger and female patients. Previous visits to a cardiologist decreased the likelihood of receiving combination therapy or angiotensin-converting enzyme inhibitors but increased that of using calcium antagonists. Apart from dose adjustment, 89% of study subjects underwent at least 1 modification to their initial regimen, at a median time of 134 days. After 1 year, only 33.8% of patients were still using their initial drug. An early decrease in the proportion of patients continuing to receive initial therapy was noted, especially among beta-blocker users.
Erratic drug-taking behaviors were observed in this Saskatchewan population. In addition, initial drug use does not seem to be in accordance with the stepped-care approach to hypertension therapy recommended in the Canadian guidelines.
The article presents study results and comparative characteristics of the influence of foridon in tablet and 5% foridon-gel on the energetic system of patients with stage I-II hypertention. It was established that efficiency of foridon increses in case of applying 5% foridon-gel.
INTRODUCTION: The "Medicinprofilen" on the website www.sundhed.dk was introduced in 2004. This paper describes the application of this tool for the evaluation of compliance of patients in pharmacological treatment of hypertension in a general practice (single). MATERIALS AND METHODS: Data about all patients with ICPC treatment code "K86 Ukompliceret hypertension", who were undergoing pharmacological treatment was used for the study. (n=296). All patients should have been treated for at least 1 year up to the data collection period which took place in the second half of the year 2005. RESULTS: We found that the "Medicinprofilen" was a suitable tool to estimate compliance. Among the patients examined we found that compliance was 95% (92.4-97.4). CONCLUSION: The "Medicinprofilen" is a suitable tool to estimate compliance of patients undergoing pharmacological treatment in general practice. A few methodical problems exist. The study showed a high rate of compliance for the group of patients undergoing treatment of hypertension.
BACKGROUND: The cytochrome P450 CYP2C9 enzyme (CYP2C9) metabolizes many clinically important drugs, for example, phenytoin, warfarin and the angiotensin II type 1 (AT(1)) receptor antagonists, losartan and irbesartan. Single nucleotide polymorphisms in the CYP2C9 gene result in the expression of three important variants, CYP2C9*1(wild-type), CYP2C9*2 and CYP2C9*3, the last two exhibiting reduced catalytic activity compared with the wild-type. The CYP2C9 genotype is known to determine sensitivity to and dose requirements for both warfarin and phenytoin, and also the rate of metabolism of losartan. However, its influence on clinical response to treatment with the AT(1) receptor antagonist, irbesartan, has not been investigated. OBJECTIVE: To determine whether the CYP2C9genotype influences the blood pressure-decreasing response to antihypertensive treatment with irbesartan. DESIGN AND METHODS: One hundred and two patients with essential hypertension and left ventricular hypertrophy were allocated randomly to groups to receive double-blind treatment with either irbesartan (n = 49) or the beta(1)-adrenergic receptor blocker, atenolol ( n= 53). Blood pressure was measured before and after 12 weeks of treatment. genotyping was performed using solid-phase minisequencing. RESULTS: The diastolic blood pressure (DBP) response differed in relation to the CYP2C9 genotype in patients given irbesartan: the reduction in patients with genotype CYP2C9*1/CYP2C9*1 (n = 33) was 7.5% and that with CYP2C9*1/CYP2C9*2 (n = 12) was 14.4% ( P= 0.036). A similar trend was seen for systolic blood pressure. In contrast, no relation was seen between the CYP2C9 genotype and blood pressure response to atenolol, a drug not metabolized via CYP2C9. CONCLUSIONS: The CYP2C9 genotype seems to predict the DBP response to irbesartan, but not to atenolol, in patients with essential hypertension.
Recent data suggest that masked hypertension (MH) carries a cardiovascular risk similar to that of uncontrolled hypertension.
The objective of this study was to determine the prevalence and determinants of MH in patients treated for hypertension in a Canadian primary care setting.
Office blood pressure (OBP) was measured at baseline and after 3 months of valsartan-based therapy in 5636 hypertensive patients who had recorded their home blood pressure monitoring (HBPM) for seven consecutive days at month 3 using an Omron HEM-711 apparatus. MH was defined in nondiabetic patients as an OBP
The uncritical promotion of intensive multipharmacological treatment for type 2 diabetic patients is an example of simplistic communication of research results. The effect, practicability and safety of pharmacological treatment is greater for high than for low levels of blood glucose and other risk factors. The large number of poorly controlled diabetic patients is a further argument for concentrating the treatment effort on those patients at highest risk. A pragmatic risk balance sheet can be used to decide when to start treatment even at relatively low levels of risk factors. We need such a framework in which we can individualise goal-setting and treatment.
For a benefit analysis of drug utilization data little reliable information is available. Benefit criteria have to be established for individual classes of drugs as well as for various types of diseases submitted to drug treatment. Antihypertensive therapy is taken as an example of how drug preferences vary from country to country and how prescribing patterns are affected by the appearance of new drugs. In the Federal Republic of Germany, fixed-ratio combinations of reserpine and diuretics are still the leading group of drugs in this field, whereas they have virtually disappeared in Great Britain and Sweden. In the latter two countries, beta-blockers are the most widely prescribed antihypertensives, and also in Germany they rank quite high in sales, but less so in the number of prescriptions. Extreme differences are found in the utilization of cardiac glycosides between Germany and Great Britain, but little is known about the consequences of risk/benefit analyses of either over- or underprescribing of these drugs. It is highly recommended to make further efforts in analyzing drug utilization data and developing studies in drug epidemiology.