Improving Treatment Effectiveness in Hypertension

Freis, Edward D.

doi:10.1001/archinte.159.21.2517

Cited by 18 publications

(11 citation statements)

References 32 publications

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“…A multipronged strategy must be adopted to improve compliance with drug therapy and lifestyle modification in patients ( Table 2) [18]. A stepwise reduction of systolic BP may be prudent in elderly patients and in those with significantly elevated systolic BP at diagnosis.…”

Section: Strategies For Optimizing Blood Pressure Controlmentioning

confidence: 99%

The need to lower systolic blood pressure

Shrivastava¹,

Kochar

2000

Current Science Inc

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Systolic hypertension is the most common form of hypertension, especially in individuals aged 60 years or older. Systolic hypertension is a reflection of decreasing compliance of large arteries and is a strong independent risk factor for all cardiovascular diseases. Despite proven benefits of therapy for systolic hypertension, only 25% of patients with this condition are adequately treated to attain target blood pressures. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of high blood pressure (JNC VI) recommends the use of diuretics and long-acting dihydropyridine calcium channel blockers as first-line therapy for isolated systolic hypertension. Therapy is also guided by comorbid conditions where certain drugs may have additional benefits. The goal of therapy should be a graded reduction in blood pressure to less than 140/90 mm Hg with lower blood pressure targets in patients with coexistent diabetes or renal failure.

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Section: Strategies For Optimizing Blood Pressure Controlmentioning

confidence: 99%

The need to lower systolic blood pressure

Shrivastava¹,

Kochar

2000

Current Science Inc

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“…Despite the guidelines and recommendations, BP control remains at sub-optimal levels (4). Non-concordance with treatment and advice is recognised as a major reason for this poor BP control (5).…”

Section: Introductionmentioning

confidence: 99%

Educational Needs for Blood Pressure Control in Chronic Kidney Disease

Stone

Khunti

et al. 2007

Journal of Renal Care

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Strict blood pressure control reduces the risk of adverse outcomes in chronic kidney disease but is difficult to achieve. To inform the design of an educational intervention for patients with chronic kidney disease and hypertension, we used focus groups to identify key patient issues, from both patient and healthcare professional perspectives. Framework methodology was used to analyse data and patient confusion emerged as the core concept. This was both an effect and, in some cases, a cause of the six key themes identified: lack of basic knowledge; conflicting advice; nature of diagnosis; changes in evidence-based practice; views on patient empowerment and views on the patient-health professional relationship. Educational needs identified involved addressing confusion by increasing both knowledge and motivation. In people with chronic kidney disease, confusion can lead to a lack of motivation and negative views that need to be addressed through appropriate education and support.

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“…5 Lifestyle changes, including alterations in dietary intake and activity patterns, may be an effective means of BP reduction; however, compliance with these measures may be low over long periods of time. 6 As such, most patients require pharmacotherapy to achieve sustained normotensive pressures. Current guidelines recommend diuretics or b-blockers as first line therapy for patients with uncomplicated hypertension on the basis of economic considerations and clinical evidence demonstrating the impact of these agents on morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Impact of Therapy Initiation with Amlodipine or Losartan on Hemodynamic Endpoints and JNC-VI Blood Pressure Stage

Putnam

Griffis²,

McLaughlin³

et al. 2006

American Journal of Therapeutics

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The relative efficacy of long-acting calcium channel antagonists and angiotensin II receptor blocking agents has been described in clinical trials; however, their effectiveness in an actual practice setting has not been well studied. This study assessed the effectiveness of 2 commonly prescribed antihypertensives, amlodipine and losartan, either as monotherapy or as add-on for patients insufficiently controlled on beta-blocker or diuretic therapy. This was a retrospective, observational study that utilized electronic medical records. Hypertensive patients more than 40 years old who were new users of amlodipine or losartan were included in the study. Patients with congestive heart failure or those using antihypertensives other than diuretics or beta-blockers were excluded. Blood pressure (BP) readings were followed up to 6 months after enrollment. Univariate and multivariate regression models were used to assess the impact of amlodipine or losartan therapy on hemodynamic end points and on JNC-VI BP stage. A total of 346 patients met the entry criteria. Of these, 275 (79.5%) amlodipine and 71 (20.5%) were prescribed losartan. Mean changes in systolic and diastolic blood pressure were greater for patients receiving amlodipine in univariate and multivariate analyses (reduction of 20/8 and 11/4 mm Hg, respectively; P<0.05). Mean change in pulse pressure trended strongly in favor of amlodipine (11.8 mm Hg vs. 7 mm Hg, P = 0.08). Univariate analysis indicated that amlodipine-treated patients were more likely to move to a better JNC-VI BP stage, where as losartan-treated patients, on average, moved to a worse stage. Amlodipine therapy was superior to losartan therapy among this population of hypertensive patients.

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Improving Treatment Effectiveness in Hypertension

Cited by 18 publications

References 32 publications

The need to lower systolic blood pressure

The need to lower systolic blood pressure

Educational Needs for Blood Pressure Control in Chronic Kidney Disease

Impact of Therapy Initiation with Amlodipine or Losartan on Hemodynamic Endpoints and JNC-VI Blood Pressure Stage

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