Management of antihypertensive drugs in three European countries

Nicotra, Federica; Wettermark, Björn; Sturkenboom, Miriam; Parodi, A. Ferretto; Bellocco, Rino; Ekbom, Anders; Merlino, Luca; Leimanis, Andrejs; Mancia, Giuseppe; Fored, Michael; Corrao, Giovanni

doi:10.1097/hjh.0b013e32832d4692

Cited by 22 publications

(11 citation statements)

References 24 publications

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“…This answers negatively the question whether using combination treatment as first step may be associated also with a better long-term BP control, possibly because two advantages of the combination, that is better BP control and tolerance profile, are major determinants of long-term compliance to treatment [18,19]. It should be emphasized, however, that this question may be more properly addressed by studies of a longer duration performed in the context of real life treatment [8,[20][21][22] because the close patient follow-up typical of clinical trials may be associated with an overall high patients' compliance which makes differences between treatment strategies more difficult to be determined.…”

Section: Discussionmentioning

confidence: 99%

Blood pressure control by the nifedipine GITS–telmisartan combination in patients at high cardiovascular risk: the TALENT study

Mancia

Parati

Bilo

et al. 2011

Journal of Hypertension

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on behalf of the TALENT investigatorsBackground Guidelines on hypertension regard combinations between two antihypertensive drugs to be the most important treatment strategy. Because of the complementary mechanism of action and the evidence of cardiovascular protective effects they include the combination of a calcium antagonist and an angiotensin receptor antagonist among the priorital ones to employ. AimsTo determine in hypertensive patients at high cardiovascular risk whether combining Nifedipine GITS at low dose and telmisartan reduced ambulatory and clinic blood pressure (BP) more than the combination components, controlled BP early after treatment initiation and allowed to also obtain a better long-term BP control compared to initiating treatment with the combination components and moving to the combination later.Methods Four hundred and five patients with a clinic SBP > -135 mmHg and with diabetes, a metabolic syndrome or organ damage were randomized to once-a-day telmisartan 80 mg, nifedipine GITS 20 mg or the combination of the two drugs in a 1 : 1 : 2 ratio for 8 weeks in the context of a multicenter double-blind study design. Patients on monotherapy were then moved to combination treatment and all three groups were followed for an additional 16-week period. Both 24-h and clinic BP were measured before treatment and at various times during treatment. ResultsIn the per-protocol patients (n U 327), baseline demographic and clinical characteristics were similar between the three groups. Baseline 24-h SBP values were 136.2 W 11.6 mmHg (mean W SD), 137.2 W 12.5 mmHg and 136.8 W 11.7 mmHg in the telmisartan monotherapy, nifedipine GITS monotherapy and combination therapy, respectively. The corresponding clinic values were 151.7 W 11.8, 151.3 W 11.9 and 151.1 W 11.8 mmHg, respectively. All treatments lowered 24-h SBP significantly (P < 0.0001) but combination treatment (8 weeks) reduced it significantly more than monotherapies (10.8 W 0.8 vs.6.6 W 1.1 mmHg and 8.0 W 1.2 mmHg; P U 0.001 and 0.037). Similar data were obtained for clinic SBP for which the combination showed a significantly greater BP reduction (12.6 W 0.6 vs. 8.6 W 0.7 mmHg and 9.3 W 0.8 mmHg; P U 0.003 and 0.024) also after 2 weeks of treatment. Moving from monotherapy to combination therapy increased the antihypertensive effect and made both ambulatory and clinic SBP superimposable in the three groups after 16 and 24 weeks of treatment. Similar findings were obtained for DBP.Conclusion Combination treatment with nifedipine GITS low dose and telmisartan provides a greater and earlier clinic and ambulatory BP reduction than the combination components in monotherapy. Initiating treatment with the combination did not result in any better longer term BP control compared to starting treatment with monotherapy and moving to the combination later.

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Section: Discussionmentioning

confidence: 99%

Blood pressure control by the nifedipine GITS–telmisartan combination in patients at high cardiovascular risk: the TALENT study

Mancia

Parati

Bilo

et al. 2011

Journal of Hypertension

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“…Treatment discontinuation, as shown by a national study based on the Swedish Prescribed Drug Register, is about 50% of the Swedish population who receive any hypertension drugs. This might contribute to poor hypertension control (34). Johnell et al identified low social participation as potential contributing factor contributing to low adherence with antihypertensive medication among the population in a southern county of Sweden.…”

Section: Discussionmentioning

confidence: 99%

Trends of blood pressure levels and management in Västerbotten County, Sweden, during 1990–2010

Carlberg

Weinehall

et al. 2012

Global Health Action

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BackgroundAvailability of longitudinal data on hypertension and blood pressure levels are important to assess changes over time at the population level. Moreover, detailed information in different population sub-groups is important to understand inequity and social determinants of blood pressure distribution in the population.ObjectivesThe objectives of this study are to: (1) describe the trends of population blood pressure levels in men and women between different educational levels and geographic areas in Sweden during 1990–2010; (2) identify prevalences of hypertension, awareness, treatment, and control in the population; and (3) assess the 10-year risk of developing hypertension among individuals with normal and high normal blood pressures.MethodsThis study is based on data from the Västerbotten Intervention Program (VIP) in Västerbotten County, Sweden. The cross-sectional analysis includes 133,082 VIP health examinations among individuals aged 30, 40, 50, and 60 years from 1990 to 2010. The panel analysis includes 34,868 individuals who were re-examined 10 years after the baseline examination. Individuals completed a self-administered health questionnaire that covers demographic and socio-economic information, self-reported health, and lifestyle behaviours. Blood pressure measurement was obtained prior to the questionnaire. In the cross-sectional analysis, trends of blood pressure by sex, and between educational groups and geographic areas are presented. In the panel analysis, the 10-year risk of developing hypertension is estimated using the predicted probability from logistic regression analysis for each sex, controlling for age and educational level.ResultsThe prevalence of hypertension decreased from 1990 to 2010; from 43.8 to 36.0% (p < 0.001) among men, and 37.6 to 27.5% among women (p < 0.001). Individuals with basic education had a significantly higher prevalence of hypertension compared to those with medium or high education. Although the decreases were observed in all geographic areas, individuals in rural inland areas had a much higher prevalence compared to those who lived in Umeå City. The proportion of hypertensive women who were aware of their hypertension (61.7%) was significantly higher than men (51.6%). About 34% of men and 42% of women with hypertension reported taking blood pressure medication. Over time, awareness and control of hypertension improved (from 46.5% in 1990 to 69% in 2010 and from 30 to 65%, respectively). The gaps between educational groups diminished. This study shows a significantly higher risk of developing hypertension for men and women with high normal blood pressure compared to those with normal blood pressure at baseline in all age cohorts and educational groups. The average risks of developing hypertension among men with high normal blood pressure were 21.5, 45.8, and 56.3% in the 30, 40, and 50-year cohorts, respectively. Corresponding numbers for women were 22.6, 47.4, and 57.9%.ConclusionsLevels of blood pressure and hypertension decreased significantly among the...

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“…W e have previously shown that in the population of Lombardy, a region with more than 10 million residents located in Northern Italy, adherence to antihypertensive drug treatment is extremely low [1][2][3]. The data were derived from the regional healthcare utilization database, which provides pharmacy-dispensing information.…”

Section: Introductionmentioning

confidence: 99%

Factors involved in the discontinuation of antihypertensive drug therapy

Mancia

Zambon

Soranna

et al. 2014

Journal of Hypertension

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Management of antihypertensive drugs in three European countries

Abstract: Management of hypertension is unsatisfactory worldwide due to a very high rate of treatment discontinuation or insufficient use of proper treatment strategies.

Cited by 22 publications

References 24 publications

Blood pressure control by the nifedipine GITS–telmisartan combination in patients at high cardiovascular risk: the TALENT study

Blood pressure control by the nifedipine GITS–telmisartan combination in patients at high cardiovascular risk: the TALENT study

Trends of blood pressure levels and management in Västerbotten County, Sweden, during 1990–2010

Factors involved in the discontinuation of antihypertensive drug therapy

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