Pharmacotherapy for mild hypertension

Diao, Diana; Wright, James M; Cundiff, David K; Gueyffier, François

doi:10.1590/s1516-31802012000600012

Cited by 39 publications

(49 citation statements)

References 7 publications

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“…20 In previous trials, most participants were already receiving antihypertensive agents before randomization or their blood pressure was substantially higher than our current definitions of grade 1 hypertension [21][22][23][24] ; previous meta-analyses are also inconclusive. 25,26 The uncertainty surrounding this important question is reflected in recent U.S. and European guidelines. 27,28 This trial evaluated blood-pressure-lowering…”

Section: Discussionmentioning

confidence: 99%

Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease

et al. 2016

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BACKGROUNDAntihypertensive therapy reduces the risk of cardiovascular events among high-risk persons and among those with a systolic blood pressure of 160 mm Hg or higher, but its role in persons at intermediate risk and with lower blood pressure is unclear. METHODSIn one comparison from a 2-by-2 factorial trial, we randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to receive either candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke; the second coprimary outcome additionally included resuscitated cardiac arrest, heart failure, and revascularization. The median follow-up was 5.6 years. RESULTSThe mean blood pressure of the participants at baseline was 138.1/81.9 mm Hg; the decrease in blood pressure was 6.0/3.0 mm Hg greater in the active-treatment group than in the placebo group. The first coprimary outcome occurred in 260 participants (4.1%) in the active-treatment group and in 279 (4.4%) in the placebo group (hazard ratio, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P = 0.40); the second coprimary outcome occurred in 312 participants (4.9%) and 328 participants (5.2%), respectively (hazard ratio, 0.95; 95% CI, 0.81 to 1.11; P = 0.51). In one of the three prespecified hypothesis-based subgroups, participants in the subgroup for the upper third of systolic blood pressure (>143.5 mm Hg) who were in the active-treatment group had significantly lower rates of the first and second coprimary outcomes than those in the placebo group; effects were neutral in the middle and lower thirds (P = 0.02 and P = 0.009, respectively, for trend in the two outcomes). CONCLUSIONSTherapy with candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day was not associated with a lower rate of major cardiovascular events than placebo among persons at intermediate risk who did not have cardiovascular disease. (Funded by the Canadian Institutes of Health Research and AstraZeneca; ClinicalTrials.gov number, NCT00468923.) a bs tr ac t

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Section: Discussionmentioning

confidence: 99%

Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease

et al. 2016

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“…3,4,5,6,7,8 In this consensus, total CVR is defined as follows: low as CVD mortality <1% at 10 years and moderate as CVD mortality ≥1% and <5% at 10 years according to the SCORE (Systematic Coronary Risk Estimation). 9 The elusiveness of the answers to the question posed are chiefly due to the lack of randomized clinical trials (RCT) that specifically evaluate treatment with anti-hypertensive drugs versus subgroups using placebo adjusted to the current definitions of grades of hypertension and absolute total CVR.…”

Section: Introductionmentioning

confidence: 99%

Clinical Perspective on Antihypertensive Drug Treatment in Adults With Grade 1 Hypertension and Low-to-Moderate Cardiovascular Risk: An International Expert Consultation

Salinas¹,

Coca

Olsen

et al. 2017

Current Problems in Cardiology

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“…Por outro lado, grupos voltados a hipertensos na atenção primária à saúde (APS) são muito comuns no Brasil, podendo obter resultados relevantes, porém são pouco pesquisados, e estudos avaliativos como os anteriormente mencionados mostram resultados significativos 9 . Todavia, mais raros ainda são estudos investigando potenciais benefícios ocorridos durante e com a participação dos hipertensos nos grupos, não quanto a desfechos clínicos finais, mas em termos de processo de cuidado e autocuidado.…”

Section: Introductionunclassified

Benefícios dos grupos no manejo da hipertensão arterial sistêmica: percepções de pacientes e médicos

Amaral

Tesser

2013

Rev Bras Med Fam Comunidade

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Artigos originAisBenefícios dos grupos no manejo da hipertensão arterial sistêmica: percepções de pacientes e médicos Benefits of groups in managing systemic arterial hypertension: perceptions of patients and physicians ResumoObjetivo: investigar a natureza dos benefícios da utilização de grupos nos serviços de atenção primária à saúde no manejo da hipertensão arterial, sob a ótica de pacientes e médicos participantes. Métodos: estudo qualitativo descritivo por meio de entrevistas semiestruturadas com pacientes e médicos participantes de grupos distintos consolidados, selecionados intencionalmente, incluídos em pares médico-paciente, até ser percebida saturação nos dados. As entrevistas foram submetidas à análise temática. Resultados e discussão: a análise das entrevistas indicou benefícios em quatro campos: educação em saúde, adesão, apoio psicossocial e melhora na qualidade de vida. Efeitos promotores de saúde foram percebidos pelos participantes, embora restritos ao nível individual e comunitário. Os grupos atenuam a "inadequação comportamental" da estratégia preventiva de alto risco, segundo Geoffrey Rose, base do manejo atual da hipertensão. Também melhoram e facilitam a função educativa dos profissionais de saúde, auxiliando na adesão e incrementando significativamente o apoio social dos pacientes. Conclusões: a utilização dos grupos de hipertensos pode melhorar o manejo da hipertensão e promover a saúde dos envolvidos e, se conduzidos de forma dialogal e participativa, seus benefícios podem ser amplificados. AbstractObjective: To investigate the nature of the benefits of using groups within primary care services to manage hypertension, from the point of view of both patients and physicians. Methods: A qualitative descriptive study using semi-structured interviews with patients and doctors attending distinct consolidated groups, which have been purposely selected and carried out in physician-patient pairs until reaching data saturation. The interviews were subjected to thematic analysis. Results and discussion: The analysis of the interviews showed benefits in four fields: health education, compliance, psychosocial support, and quality of life improvement. Health promoting effects were perceived by participants, although restricted to individual and community levels. Participation in groups attenuates the "behavioral inadequacy" of high-risk preventive strategy, according to Geoffrey Rose, based on current management of hypertension. It also improves and facilitates health professionals' educational role, improving compliance and significantly increasing social support for patients. Conclusions: The use of groups for hypertensive patients can improve hypertension management and promote the health of those involved. These benefits can be amplified if management is conducted in a dialogical and participatory way.

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Pharmacotherapy for mild hypertension

Cited by 39 publications

References 7 publications

Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease

Blood-Pressure Lowering in Intermediate-Risk Persons without Cardiovascular Disease

Clinical Perspective on Antihypertensive Drug Treatment in Adults With Grade 1 Hypertension and Low-to-Moderate Cardiovascular Risk: An International Expert Consultation

Benefícios dos grupos no manejo da hipertensão arterial sistêmica: percepções de pacientes e médicos

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