Goal-Oriented Hypertension Management

Singer, Gregory M.; Izhar, Munavvar; Black, Henry R.

doi:10.1161/01.hyp.0000035858.04434.03

Cited by 76 publications

(7 citation statements)

References 21 publications

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“…In this study, 42.7% and 40% of the participants reached target SBP and DBP, respectively. The proportion achieved the target SBP and DBP were lower than those reported in the studies conducted in Australia [15] and USA [17, 18]. This discrepancy might be due to race [19, 20], low socioeconomic status, poor adherence to standard guidelines, inappropriate choice of antihypertensive drugs by clinicians [6], poor adherence to treatment by hypertensive patients, physician inertia, deficiencies of healthcare systems in their approach to chronic diseases [21], lack of drug availability at health facility, unaffordability of drugs by patients, and less aggressive treatment [22].…”

Section: Discussioncontrasting

confidence: 61%

Assessment of hypertension control and factors associated with the control among hypertensive patients attending at Zewditu Memorial Hospital: a cross sectional study

2019

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ObjectiveThis study was conducted to assess hypertension control and factors associated with it among hypertensive patients on treatment at Zewditu Memorial Hospital.ResultsA total of 225 patients were included in the study, of which 55.6% of patients were females. The mean age of the patients was 55.2 years and half of them had a family history of hypertension. About 29% of patients had comorbidities. Angiotensin-converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs) and beta-blockers (BBs) were the most frequently prescribed medications. Majority of (83.1%) the patients received combination therapy. The most frequent two and three drugs class combination were ACEI + BB and ACEIs + CCB + BB, respectively. Drug treatment was modified for 22.2% of patients and blood pressure (BP) was controlled in 26.2% of patients. Older age was associated with good BP control (AOR 2.58, CI 1.27–5.24), while treatment modification was associated with poor BP control (AOR 0.21, CI 0.07–0.65). The findings indicate that BP control was low and factors like middle age and treatment modification contributed to the low BP control. It is recommended that the physicians should be adherent to current guidelines regarding the selection of appropriate antihypertensive medications so as to achieve target BP goals.Electronic supplementary materialThe online version of this article (10.1186/s13104-019-4173-8) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 61%

Assessment of hypertension control and factors associated with the control among hypertensive patients attending at Zewditu Memorial Hospital: a cross sectional study

2019

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“…It has been observed that restrictions in diuretic use were the primary cause of resistant hypertension in patients with CKD [156]. Restricted diuretic use includes either lower doses or inappropriate drug selection; thiazides are usually not effective when GFR is lower than 40 and should, therefore, be replaced by loop diuretics in such patients.…”

Section: Chronic Kidney Diseasementioning

confidence: 99%

“…Another contributor to treatment resistance is the use of inappropriate drug combinations or suboptimal doses of antihypertensive drugs. Indeed, a study of patients with resistant hypertension revealed that simple measures, such as increasing diuretic dosing or switching to appropriate diuretics, can result in significant blood pressure reductions [156]. …”

Section: Rational For the Management Of Resistant Hypertensionmentioning

confidence: 99%

Common Secondary Causes of Resistant Hypertension and Rational for Treatment

Faselis

Doumas

Papademetriou

2011

International Journal of Hypertension

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Resistant hypertension is defined as uncontrolled blood pressure despite the use of three antihypertensive drugs, including a diuretic, in optimal doses. Treatment resistance can be attributed to poor adherence to antihypertensive drugs, excessive salt intake, physician inertia, inappropriate or inadequate medication, and secondary hypertension. Drug-induced hypertension, obstructive sleep apnoea, primary aldosteronism, and chronic kidney disease represent the most common secondary causes of resistant hypertension. Several drugs can induce or exacerbate pre-existing hypertension, with non-steroidal anti-inflammatory drugs being the most common due to their wide use. Obstructive sleep apnoea and primary aldosteronism are frequently encountered in patients with resistant hypertension and require expert management. Hypertension is commonly found in patients with chronic kidney disease and is frequently resistant to treatment, while the management of renovascular hypertension remains controversial. A step-by-step approach of patients with resistant hypertension is proposed at the end of this review paper.

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“…This indicates that treating blood pressure is much less effective in controlling blood pressure in Japan. This could be the result of differences in aggressiveness of treatment, different drug regimens [13] , drug titration, patient compliance with medication [14] , physician compliance with recommended blood pressure levels [15] , or resistance of hypertension to treatment [13] .…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and control of hypertension in the elderly populations of Japan and the United States

Saito¹,

Davarian²,

Takahashi³

et al. 2015

IJPS

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The Japanese have the highest life expectancy in the world while the United States (U.S.) has relatively low life expectancy. Furthermore, the Americans have relatively poorer health compared to the Japanese. Examination of the treatment of specific conditions such as hypertension in these two countries may provide insights into how the health care system contributes to the relative health in these two countries. In this study, we focus on the treatment of hypertension, as this is the most common condition requiring therapeutic interventions in seniors. This study examines hypertension diagnoses and controls in nationally representative samples of the older populations (68 years-or-older) of Japan and the U.S. Data come from two nationally representative samples: the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) (n=2,309) and the U.S. Health and Retirement (HRS) Study (n=3,517). The overall prevalence of hypertension is higher in Japan than the U.S. Undiagnosed hypertension is about four times higher in Japan than in the U.S., while the control of blood pressure is more than four times higher in the U.S. than in Japan. Thus, the use of antihypertensive medication is much more frequent and more effective in the U.S. The medical care system seems to be more effective in controlling hypertension in the U.S. than in Japan. This may be due to the more aggressive diagnosis and treatment of hypertension in the U.S.

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Goal-Oriented Hypertension Management

Cited by 76 publications

References 21 publications

Assessment of hypertension control and factors associated with the control among hypertensive patients attending at Zewditu Memorial Hospital: a cross sectional study

Assessment of hypertension control and factors associated with the control among hypertensive patients attending at Zewditu Memorial Hospital: a cross sectional study

Common Secondary Causes of Resistant Hypertension and Rational for Treatment

Diagnosis and control of hypertension in the elderly populations of Japan and the United States

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