Facing the Challenge of Lowering Blood Pressure and Cholesterol in the Same Patient: Report of a Symposium at the European Society of Hypertension

Williams, Bryan; Masi, Stefano; Wolf, Jacek; Schmieder, Roland E.

doi:10.1007/s40119-019-00159-1

Cited by 24 publications

(21 citation statements)

References 37 publications

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“…Ensure screening for poor medication adherence is integral to each patient visit as adherence may vary with time 21 …”

Section: Resultsmentioning

confidence: 99%

“…6 In addition to the above evidence, the identified literature further highlighted other factors likely to contribute to sub-optimal lipid lowering. These included late intervention in the disease trajectory, 21 a lack of follow-up and treatment adaptation according to risk factors or fulfilment of therapeutic goals, and statin intolerance. 8 While generally well-tolerated by patients, it is known that statins can lead to specific adverse effects on muscles, and other adverse events such as impaired glucose homeostasis and hemorrhagic stroke in some patients.…”

Section: Sub-optimal Achievement Of Guideline-derived Lipid Modification Goalsmentioning

confidence: 99%

“…• Provide patient counselling and education at the onset of treatment, including discussion about the overall safety, risks and benefits of treatment, 9 to ensure the patient is supported and understands the risk of CVD events 37,44 • Cost-effective single pill combinations 21 Statin intolerance AND/OR reluctance…”

Section: Underdosing Of Statinsmentioning

confidence: 99%

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Current Perspectives on the Attainment of Lipid Modification Goals Relating to the Use of Statins and Ezetimibe for the Prevention of Cardiovascular Disease in the United Kingdom

Reynolds¹,

Pottle²,

Quoraishi³

2021

VHRM

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Despite widespread evidence of the effectiveness of lipid modification for the reduction of cardiovascular disease (CVD) risk, lipid modification goals are commonly underachieved in the United Kingdom (UK). In order to understand current UK lipid management guidance and the corresponding attainment of recommended lipid lowering goals relating to treatment with statins and ezetimibe, a literature review was conducted using PubMed focusing on publications between January 2017 and February 2020 in order to capture the most up-to-date literature. Identified publications were reviewed against key clinical guidelines for lipid management in relation to CVD risk from the National Institute for Health and Care Excellence (NICE, CG181), the Scottish Intercollegiate Guidelines Network (SIGN, 149) and European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS). Cholesterol lowering goals are central to current lipid lowering therapy guidance, although specific goals vary depending on the guideline and patients' individual risk profile. Current guidance by NICE and SIGN specifies that treatment should achieve a greater than 40% reduction in non-high-density lipoprotein cholesterol (non-HDL-C) at 3 months of treatment, while the ESC/EAS place emphasis on the lowering of lowdensity lipoprotein (LDL-C) and total cholesterol. Yet, despite widespread availability of guidance and consistent messaging that lipid lowering goals should be ambitious, current evidence suggests a significant proportion of UK patients have sub-optimal reductions in cholesterol/non-HDL-C/LDL-C. The reasons for this are reported to be multifactorial, including a lack of compliance with guidelines, particularly regarding high-intensity statin prescribing, patient adherence, statin intolerance and statin reluctance as well as wider genetic factors. A number of possible strategies to improve current lipid management and attainment of lipid-lowering goals were identified, including improving the patient-healthcare professional partnership, conducting audits of local prescribing versus guidance, implementing plans for the refinement of current services and considering alternative options such as cost-effective single pill combinations for improving adherence.

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“…Ensure screening for poor medication adherence is integral to each patient visit as adherence may vary with time 21 …”

Section: Resultsmentioning

confidence: 99%

Section: Sub-optimal Achievement Of Guideline-derived Lipid Modification Goalsmentioning

confidence: 99%

See 1 more Smart Citation

Current Perspectives on the Attainment of Lipid Modification Goals Relating to the Use of Statins and Ezetimibe for the Prevention of Cardiovascular Disease in the United Kingdom

Reynolds¹,

Pottle²,

Quoraishi³

2021

VHRM

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“…Successful treatment of hypertension in contemporary practice faces several barriers: poor adherence to treatment regimens, physician inertia and insufficient use of combination therapies, among others. In particular, nonadherence is a complex phenomenon involving pill burden, patient reluctance to depend on life-long medical therapy, experiencing adverse events or drug side effects and biased perception of the benefit/risk ratio for drugs [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Differences in patient and physician perspectives on pharmaceutical therapy and renal denervation for the management of hypertension

Schmieder

Kandzari

Wang

et al. 2020

Journal of Hypertension

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Objective: To study patient and physician attitudes to pharmaceutical therapy and renal denervation for the management of hypertension. Methods: Data were analyzed from 19 market research studies in Western Europe and the United States conducted between 2010 and 2019 to obtain quantitative and qualitative perspectives. The analysis incorporated insights from 2768 patients and the experiences of 1902 physicians either actively performing or interested to perform device procedures, or hypertension specialists who would refer patients for a device-based intervention. Results: Referring cardiologists and proceduralists were more likely to recommend the renal denervation procedure to patients with higher BP levels and a greater number of antihypertensive medications. Physicians perceived patient reluctance towards a procedure as an important obstacle to recommending renal denervation as a treatment option for uncontrolled hypertension. Patient interest in the renal denervation procedure did not correlate with BP severity ( P = NS), and the highest preference for the procedure was in patients diagnosed with hypertension but not receiving treatment ( P < 0.001). Patients who perceived high BP as a major problem ( P = 0.029) and those who experienced side effects attributed to their BP medications ( P = 0.006) had a higher preference for renal denervation. Conclusion: Patients with hypertension often regard the choice of renal denervation to lower BP differently from physicians. A considerable proportion of hypertensive patients, especially those not taking medications, may prefer a device-based approach to reduce their BP.

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“…Despite the recommendations of the current guidelines and the efforts made to develop an algorithm for an optimal approach to arterial hypertension, of the progress made in monitoring the patients and pharmacological treatments, only 40% of hypertensive patients have controlled blood pressure values [ 7 ]. The lack of arterial hypertension control in two thirds of the patients has raised the issue of the necessity for a better therapeutic strategy.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Compliance of Patients with Arterial Hypertension in Primary Care

et al. 2020

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Background and Objectives: Arterial hypertension remains an important cause of cardiovascular morbidity and mortality, despite all the progress made in the methods of diagnosis, monitoring of target organs’ damage and treatment. The main cause of the increased prevalence of uncontrolled blood pressure values is the low compliance to antihypertensive treatment. The objective of our study was to assess the compliance to the treatment of patients diagnosed with arterial hypertension and monitored in a primary care office. Materials and Methods: The cross-sectional, retrospective study included 129 patients, 65.89% (85) women, previously diagnosed with arterial hypertension. Data from the medical files were analyzed, as well as the patients’ answers to a survey of 18 questions regarding arterial hypertension, comorbidities, complications, treatment and awareness of the condition. Results: The study included 129 patients, with a mean age of 66 ± 8 years. The majority of patients were overweight, 55.81% (72 patients), and 10.85% (14 patients) had grade I obesity. Most of the patients, 55.81% (72 patients) were diagnosed with grade III hypertension, while 37.98% (49 patients) were diagnosed with grade II hypertension and 6.2% (8 patients) with grade I hypertension. One third of the surveyed patients answered that they follow the recommendations of a low-sodium diet, 21.7% are adherent to treatment, but 56% think that the total cost of the medication is an impediment for their compliance to treatment. The majority, 82.17% (106 patients), of respondents had an affirmative answer to the questions: ‘Do you think it would be easier to take one pill instead of 2, 3 or 4 pills?’ Conclusion: The increased compliance to the antihypertensive treatment and control of blood pressure values are associated with the degree of awareness of arterial hypertension and the consequences if left untreated, emphasizing the role of the general practitioner in counseling for secondary prevention.

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Facing the Challenge of Lowering Blood Pressure and Cholesterol in the Same Patient: Report of a Symposium at the European Society of Hypertension

Cited by 24 publications

References 37 publications

Current Perspectives on the Attainment of Lipid Modification Goals Relating to the Use of Statins and Ezetimibe for the Prevention of Cardiovascular Disease in the United Kingdom

Current Perspectives on the Attainment of Lipid Modification Goals Relating to the Use of Statins and Ezetimibe for the Prevention of Cardiovascular Disease in the United Kingdom

Differences in patient and physician perspectives on pharmaceutical therapy and renal denervation for the management of hypertension

Therapeutic Compliance of Patients with Arterial Hypertension in Primary Care

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