National Recommendations for the Pharmacological Treatment of Hypertension

Moser, Marvin

doi:10.1001/archinte.159.13.1403

Cited by 11 publications

(3 citation statements)

References 20 publications

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“…This approach was advocated in several subsequent reviews in the late 1990s. 19,20 More recent studies have confirmed the efficacy of ACE inhibitors in reducing cardiovascular events 21 ; other studies of ACE inhibitors are under way. 22 This evidence is reassuring, given the frequent use of ACE inhibitors as single-agent therapy in the 1995 NAMCS study, the 1999 VA study, and our study.…”

Section: Discussionmentioning

confidence: 99%

Hypertension Management and Control in Primary Care: A Study of 20 Practices in 14 States

2004

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Study Objective. To describe the management and control of hypertension in primary care practice. Design. Retrospective medical record review. Setting. Twenty primary care practices in 14 states. Patients. Thirteen thousand forty-seven patients with hypertension. Measurements and Main Results. Diagnoses, drugs prescribed, and blood pressure readings were extracted from the electronic medical record at each practice in the study. For patients with hypertension and comorbid diagnoses, the most recent blood pressure and antihypertensive drugs prescribed were determined. Analyses assessed the blood pressure control rates and the association between control and demographic variables, frequency of visits to the practice site, and pharmacologic treatment patterns. Among the 20 practices in the study, 13,047 patients had received a diagnosis of hypertension and their blood pressures had been measured within the previous 12 months. One third of the patients had comorbid coronary heart disease, diabetes mellitus, heart failure, and/or renal insufficiency. The most recent blood pressure reading was below 140/90 in half the patients. Control was associated with age 60 years or younger, female sex, more than one visit to the practice, more than one comorbidity, and type of practice (p<0.01, logistic regression). Wide variability was noted among practices in the use of multiagent antihypertensive therapy, and in antihypertensive therapy by drug class. Among patients without comorbidity treated with one drug, systolic blood pressure did not differ significantly by drug class. Diastolic blood pressure was slightly lower in patients prescribed thiazide diuretics than in those prescribed angiotensin receptor blockers (p=0.03, analysis of covariance). Conclusion. Blood pressure control in primary care practice can be much better than reports usually indicate. Good control in this study was not due to specific drug choice, but instead may have been due to regular monitoring of blood pressure and motivation of the practice to improve patient care.

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Section: Discussionmentioning

confidence: 99%

Hypertension Management and Control in Primary Care: A Study of 20 Practices in 14 States

2004

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“…In general, fewer than half of study participants received a firstline antihypertensive medication-whether they suffered from essential hypertension or hypertension with diabetes, ischemic heart disease, or congestive heart failure. Furthermore, in each case, more than a third of hypertensive subjects were on a calcium channel blocker, one of the higher cost new agents whose superiority to diuretics and/or β-blockers in both controlling high blood pressure and preventing future negative cardiac events has yet to be established in long-term clinical trials (Psaty et al 1995;Moser 1998;Psaty et al 1997;Pahor et al 2000;Kizer and Kimmel 2001;Moser 1999Moser , 2001Appel 2002;Psaty et al 2003).…”

Section: Discussionmentioning

confidence: 99%

Translating Research into Practice: Are Physicians Following Evidence-Based Guidelines in the Treatment of Hypertension?

Holmes

Shevrin²,

Goldman³

et al. 2004

Med Care Res Rev

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Despite the widespread availability of evidence-based guidelines for treating hypertension, recent evidence suggests that physicians may not be prescribing first-line drugs for their patients with high blood pressure. Using administrative claims data from 1998 through 2000, this study investigates whether drug treatment provided to 6,736 hypertensives in a privately insured, non-HMO population follows practice guidelines. The authors also examine physician and patient-related factors associated with guideline adherence in a subset of patients with newly diagnosed hypertension. Among members with high blood pressure alone, only 38 percent were on a diuretic, while less than a third were prescribed a beta-blocker, the JNC VI recommended first-line antihypertensives for essential hypertension. Approximately half of individuals with high blood pressure and certain comorbidities received non-first-line interventions. Such findings indicate the need to reconsider how guidelines are communicated and shared with medical practitioners and patients, particularly in light of the drug industry's promotion of newer, more expensive drugs.

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“…Based on these trials, it is clear that ACE inhibitors or ACE/diuretic combinations should also be included as first-step therapy choices. 35 Whether the ARBs should be listed among the preferred initial therapies is debatable at present. There are enough data to indicate their use in diabetics, especially those patients with diabetic nephropathy, and some data to suggest a reduction in CV events with their use, but additional data are necessary.…”

Section: Combination Therapymentioning

confidence: 99%

Update on the Management of Hypertension: Do Recent Clinical Trial Results Indicate a Change in National Recommendations for Therapy?

Moser

2002

J of Clinical Hypertension

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Numerous hypertension treatment trials have been reported during the past several years. In comparative studies it has been shown that the use of diuretics or diuretics/β blockers has resulted in a reduction in mor-T his review will summarize the recommendations of the 1997 Joint National Committee on Prevention, Diagnosis, Evaluation, and Treatment of High Blood Pressure (JNC VI) 1 and discuss possible changes in these based on the results of clinical trials held over the past 3-4 years.In 1997 the JNC VI emphasized the importance of systolic blood pressure (SBP) both in estimating risk and guiding therapy. This point should be reemphasized. Most physicians would not hesitate to treat a patient with a persistent diastolic blood pressure (DBP) of 95-100 mm Hg but, based on recent treatment surveys, many do not treat an SBP of 150-159 mm Hg. Yet, the relative risk of a cardiac event with this level of SBP is considerably greater than the risk of a DBP of 95-100 mm Hg (Figure 1). 2 A majority of hypertensive patients who are uncontrolled are those with SBP elevations. In addition, data from Framingham indicate that over time people with SBP levels of 140-159 mm Hg have a poorer prognosis when compared to those with SBPs below 140 mm Hg (Table I). 3 At the end of a long follow-up period, cardiovascular (CV) disease, coronary heart disease, transient ischemic attacks, heart failure, and CV disease deaths were all increased statistically significantly more in those individuals who originally had this degree of

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National Recommendations for the Pharmacological Treatment of Hypertension

Cited by 11 publications

References 20 publications

Hypertension Management and Control in Primary Care: A Study of 20 Practices in 14 States

Hypertension Management and Control in Primary Care: A Study of 20 Practices in 14 States

Translating Research into Practice: Are Physicians Following Evidence-Based Guidelines in the Treatment of Hypertension?

Update on the Management of Hypertension: Do Recent Clinical Trial Results Indicate a Change in National Recommendations for Therapy?

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