Antihypertensive treatment and control in a large primary care population of 21 167 patients

Qvarnström, Miriam; Wettermark, Björn; Ljungman, Charlotta; Zarrinkoub, Ramin; Hasselström, Jan; Manhem, Karin; Sundström, Anders; Kahan, Thomas

doi:10.1038/jhh.2010.86

Cited by 35 publications

(34 citation statements)

References 35 publications

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“…These aspects of socioeconomic factors extend previous findings concerning differences in prescription pattern between women and men. 3,6,29 In patients with an educational level of 412 years, women were not prescribed aldosterone antagonists, beta receptor blocker and loop diuretics more often than men. In comparison, women with an educational level of o 12 years were more often prescribed aldosterone antagonists, beta receptor blockers and loop diuretics.…”

Section: Discussionmentioning

confidence: 99%

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Antihypertensive treatment and control according to gender, education, country of birth and psychiatric disorder: the Swedish Primary Care Cardiovascular Database (SPCCD)

et al. 2014

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The reasons why women and men are treated with different antihypertensive drugs are not clear. Whether socioeconomic factors influence prescription patterns and blood pressure control differently in women and men has not been investigated. This cross-sectional study performed in a cohort of hypertensive patients from the Swedish Primary Care Cardiovascular Database (SPCCD) examined the influence of educational level, country of birth, gender and concomitant psychiatric disorder on prescription pattern and blood pressure control in 40,825 hypertensive patients. Men were more often than women treated with calcium channel blocker and angiotensin-converting enzyme inhibitor (ACEI), irrespective of education, country of birth and psychiatric disorder. Educational level influenced the prescription pattern to some extent, where the gender differences were reduced in patients with a higher educational level. In women, but not in men, high educational level and concomitant psychiatric disorder were associated with a higher proportion reaching target blood pressure. The predominant use of ACEI and calcium channel blockers in men is not influenced by educational level, country of birth or psychiatric disorder. Thus other explanations must be considered such as gender differences in side effects. Educational level seems to have a greater impact on reaching target blood pressure in women compared with men.

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Section: Discussionmentioning

confidence: 99%

“…Women receive different antihypertensive drug treatment and attain higher blood pressure levels than men. [2][3][4] In general women are more often treated with diuretics and less often with angiotensin-converting enzyme inhibitor (ACEI) than men. 5,6 These gender differences are not fully understood.…”

Section: Introductionmentioning

confidence: 99%

Antihypertensive treatment and control according to gender, education, country of birth and psychiatric disorder: the Swedish Primary Care Cardiovascular Database (SPCCD)

et al. 2014

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“…Secondary endpoints included: the percentage of patients achieving the cumulative SeSBP goal of , 140/90 mm Hg (or , 130/80 mm Hg for patients with T2DM) during weeks 12 and 20 of treatment; the mean change from baseline in SeSBP and SeDBP after 4,8,12,16, and 20 weeks of active treatment; changes from baseline in mean 24-hour ambulatory BP at weeks 12 and 20; and the achievement of American Heart Association (AHA)-recommended ambulatory BP targets of , 130/80 mm Hg for mean 24-hour ambulatory BP, , 135/85 mm Hg for mean daytime (8 am-4 pm) ambulatory BP, and , 120/70 mm Hg for mean nighttime (10 pm-6 am) ambulatory BP. 11 Safety assessments included the evaluation of adverse events (AEs), laboratory parameters (assessed at screening, week 12, and week 20), and physical examination.…”

Section: Study Assessmentsmentioning

confidence: 99%

“…4,5 Despite this observation, a large percentage of patients with hypertension (up to 60%) only receive monotherapy, and most (60%-70%) of these patients do not achieve target BP levels. [6][7][8] For such patients, fixed-dose combination therapy can help to simplify the treatment regimen and potentially improve adherence. This is based on the finding that the number of medications taken is correlated with nonadherence, primarily related to increased complexity and/or cost.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Amlodipine/Olmesartan Medoxomil ± Hydrochlorothiazide in Patients Aged ≥ 65 or < 65 Years With Uncontrolled Hypertension on Prior Monotherapy

Weir¹,

Shojaee²,

Maa³

2013

Postgraduate Medicine

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Our subanalysis evaluated the efficacy of an amlodipine/olmesartan medoxomil (AML/OM)-based titration regimen to achieve blood pressure (BP) goals among patients aged ≥ 65 years. In this dose-titration study, 999 patients (228 of whom were aged ≥ 65 years) with uncontrolled BP after ≥ 1 month of monotherapy were switched to fixed-dose AML/OM 5/20 mg and uptitrated every 4 weeks to AML/OM 5/40 and 10/40 mg to achieve BP < 120/70 mm Hg. Patients were subsequently uptitrated every 4 weeks to AML/OM 10/40 mg + hydrochlorothiazide (HCTZ) 12.5 mg and AML/OM 10/40 mg + HCTZ 25 mg to achieve BP < 125/75 mm Hg. The primary efficacy endpoint (ie, the cumulative percentage of patients achieving the seated cuff systolic BP goal of < 140 mm Hg [or < 130 mm Hg for patients with type 2 diabetes mellitus] during first 12 weeks of treatment) was achieved by 76.7% and 75.6% of patients aged ≥ 65 (ie, 65-80) years and < 65 (ie, 18-64) years, respectively. For patients aged ≥ 65 and < 65 years, mean seated cuff BP changes from baseline during the titration periods ranged from -14.5/-7.8 mm Hg and -14.1/-7.7 mm Hg, respectively, for AML/OM 5/20 mg, to -28.5/-12.4 and -24.5/-14.0 mm Hg for AML/OM 10/40 mg + HCTZ 25 mg (all P < 0.0001). By week 20, the cumulative BP threshold of < 140/90 mm Hg was achieved by 86.8% and 84.2% of patients aged ≥ 65 and < 65 years, respectively. Among patients aged ≥ 65 years who underwent ambulatory BP monitoring, mean 24-hour, daytime, and nighttime ambulatory BP all decreased from baseline at weeks 12 and 20 (all P < 0.0001). At weeks 12 and 20, the mean 24-hour American Heart Association-recommended ambulatory BP target of < 130/80 mm Hg was achieved in 80.4% and 97.4% of patients aged ≥ 65 years, respectively, and in 71.3% and 88.8% of patients aged < 65 years, respectively. The majority of adverse events were mild to moderate in intensity and the incidence of treatment-emergent adverse events determined by clinical laboratory evaluation was low. The incidence of drug-related hypotension and orthostatic hypotension in patients aged ≥ 65 years was 2.2% and 0.0%, respectively, and in patients aged < 65 years, was 2.3% and 0.3%, respectively. Fixed-dose AML/OM ± HCTZ combination therapy effectively lowered BP and achieved BP goals in patients aged ≥ 65 and < 65 years with hypertension previously uncontrolled on monotherapy. The treatment regimen was well tolerated irrespective of patient age.

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“…Observational studies have reported a different choice of anti-hypertensive drug classes in the treatment of men and women worldwide, with the former more often receiving angiotensinconverting enzyme inhibitor (ACE-I) and the latter more likely to be on diuretics [83,84]. More importantly, gender disparities have been reported in terms of blood pressure control [85][86][87][88][89].…”

Section: Gender Difference In Response To Other Cardiovascular Pharmamentioning

confidence: 99%

Gender differences in cardiovascular prophylaxis: Focus on antiplatelet treatment

Giosia

Passacquale

Petrarca

et al. 2017

Pharmacological Research

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Cardiovascular disease (CVD) represents the leading cause of death worldwide, and equally affects both sexes although women develop disease at an older age than men. A number of clinical evidence has identified the female sex as an independent factor for poor prognosis, with the rate of mortality and disability following an acute cardiovascular (CV) event being higher in women than men. It has been argued that the different level of platelet reactivity between sexes may account for a different responsiveness to anti-platelet therapy, with consequent important implications on clinical outcomes. However, conclusive evidence supporting the concept of a gender-dependent effectiveness of platelet inhibitors are lacking. On the contrary, sex-related dissimilarities have been evidenced in cardiovascular patients in terms of age of presentation, comorbidities such as obesity, diabetes and renal disease, and a different pharmacological approach to and effectiveness in controlling classical cardiovascular risk factors such as hypertension, glucose profile and lipid dysmetabolism. All these factors could place women at an increased level of cardiovascular risk compared to men, and may concur to an enhanced pro-thrombogenic profile. The purpose of this manuscript is to provide an overview of gender-related differences in cardiovascular treatment, in order to highlight the need to improve the pharmacological prophylaxis adopted in women through a more accurate evaluation of the overall cardiovascular risk profile with consequent establishment of a more effective and targeted anti-thrombotic strategy which is not limited to the use of antiplatelet agents.

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Antihypertensive treatment and control in a large primary care population of 21 167 patients

Cited by 35 publications

References 35 publications

Antihypertensive treatment and control according to gender, education, country of birth and psychiatric disorder: the Swedish Primary Care Cardiovascular Database (SPCCD)

Antihypertensive treatment and control according to gender, education, country of birth and psychiatric disorder: the Swedish Primary Care Cardiovascular Database (SPCCD)

Efficacy of Amlodipine/Olmesartan Medoxomil ± Hydrochlorothiazide in Patients Aged ≥ 65 or < 65 Years With Uncontrolled Hypertension on Prior Monotherapy

Gender differences in cardiovascular prophylaxis: Focus on antiplatelet treatment

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