Better blood pressure control: how to combine drugs

Brown, Morris J.; Cruickshank, J.; Dominiczak, Anna F.; MacGregor, Graham A.; Poulter, Neil; Russell, G. I.; Thom, Simon; Williams, Bryan

doi:10.1038/sj.jhh.1001511

Cited by 124 publications

(72 citation statements)

References 35 publications

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“…Recent studies have shown that the target systolic blood pressure of 140 mmHg can be achieved 9,10 if a protocol is followed and individuals are treated with rational combinations of two to three drugs. 11 Furthermore, very little is …”

Section: Discussionmentioning

confidence: 99%

Cost of poor blood pressure control in the UK: 62 000 unnecessary deaths per year

MacGregor

2003

J Hum Hypertens

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Section: Discussionmentioning

confidence: 99%

Cost of poor blood pressure control in the UK: 62 000 unnecessary deaths per year

MacGregor

2003

J Hum Hypertens

Self Cite

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“…We estimated the proportions of subjects who were prescribed different major drug classes during the study period. The major classes were labelled following Brown et al: 23 A, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers; B, beta-blockers; C, calcium antagonists; D, thiazide diuretics including potassium-sparing diuretics and potassium-sparing diuretic combinations. Data for subjects who were not treated with antihypertensive drugs are tabulated separately.…”

Section: Methodsmentioning

confidence: 99%

Trends in antihypertensive and lipid-lowering therapy in subjects with type II diabetes: clinical effectiveness or clinical discretion?

Gulliford

Charlton²,

Latinovic³

2004

J Hum Hypertens

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Hypertension and lipid disorders in type II diabetes contribute to increased coronary risk, but optimal drug therapy has not been defined. We investigated primary care physicians choices of antihypertensive and lipidlowering therapy for subjects with type II diabetes diagnosed with hypertension. Subjects were registered with 105 UK general practices in the General Practice Research Database and prescribed oral hypoglycaemic drugs for the first time between January 1993 and December 2001. We evaluated prescriptions for antihypertensive drugs in subjects with secondary diagnoses of hypertension in the first year following initiation of oral hypoglycaemic therapy. Data were analysed for 4519 diabetic subjects with diagnosed hypertension. Between 1993 and 2001, the proportion prescribed thiazide diuretics increased from 20 to 30%; angiotensin-converting enzyme (ACE) inhibitors from 35 to 45% and angiotensin receptor blockers from 0 to 8%.The proportion of subjects prescribed lipid-lowering therapy increased from 8% in 1993 to 33% in 2001, with the proportion prescribed statins increasing from 1 to 30%. At different general practices, the proportion prescribed thiazide diuretics ranged from 0 to 52%, betablockers from 5 to 60%, ACE inhibitors from 15 to 81%, and statins from 0 to 50%. Variation between practices was not explained by adjusting for age, sex, prevalent coronary heart disease or study year. Trends in drug utilisation were consistent with the evolving evidence base but there were wide variations in drug utilisation between practices. A more consistent approach to drug selection might be associated with improved patient outcomes.

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“…Ethnicity plays an important role in the pharmacological actions of antihypertensive drugs. 28 It is well documented that black races responds better to diuretics than non-blacks 29 presumably because of lower-rennin status, 30 hence further research is required with other races. …”

Section: Interpretation and Relationship With Published Literaturesmentioning

confidence: 99%

Profiles of mortality among Chinese hypertensive patients in Hong Kong: a cohort study

et al. 2009

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We studied the profiles of all-cause and cardiovascular (CVS) mortality among users of different antihypertensive classes in a Chinese population. From electronic patient records, a cohort study was conducted among 18 338 patients who ever newly prescribed an a-blocker, thiazide diuretic, b-blocker, calcium channel blocker (CCB) or agents acting on the renin-angiotensin system (RAS) without drug discontinuation or switching in the public primary-care sector in a large Territory of Hong Kong during January 2004-June 2007. The odds ratios of mortality (all-cause and CVS) were evaluated according to the prescribed antihypertensive drug classes by Cox proportional hazards regression analyses. A total of 823 deaths (4.5%) were reported during the study period. The crude proportions of all-cause mortality were highest in a-blockers (6.2%) and CCB (5.7%), but lowest in b-blockers (2.8%). Compared with CCB, patients on thiazide diuretics were shown to have statistically significantly lower all-cause (adjusted hazard ratios (aHRs) 0.75, 95% CI 0.60, 0.93, P ¼ 0.010) and CVS mortality (aHR 0.40, 95% CI 0.21, 0.78, P ¼ 0.007), but the 95% CI of the odds ratios of the major drug classes overlapped. When each drug class was used as a reference group, or when patients with only uncomplicated hypertension were included, their respective 95% CI similarly overlapped. Antihypertensive drug classes were associated with statistically comparable odds of all-cause and CVS mortality. This finding from real-life clinical practice further supports the position statements from international guidelines, which recommend that the major antihypertensive drug classes are suitable for initiating pharmacotherapy for the management of hypertension.

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Better blood pressure control: how to combine drugs

Cited by 124 publications

References 35 publications

Cost of poor blood pressure control in the UK: 62 000 unnecessary deaths per year

Cost of poor blood pressure control in the UK: 62 000 unnecessary deaths per year

Trends in antihypertensive and lipid-lowering therapy in subjects with type II diabetes: clinical effectiveness or clinical discretion?

Profiles of mortality among Chinese hypertensive patients in Hong Kong: a cohort study

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