Renal Outcomes in High-Risk Hypertensive Patients Treated With an Angiotensin-Converting Enzyme Inhibitor or a Calcium Channel Blocker vs a Diuretic

Rahman, Mahboob; Pressel, Sara L.; Davis, Barry R.; Nwachuku, Chuke; Wright, Jackson T.; Whelton, Paul K.; Barzilay, Joshua I.; Batuman, Vecihi; Eckfeldt, John H.; Farber, Michael A.; Henriquez, Mario; Kopyt, Nelson; Louis, Gail T.; Saklayen, Mohammad G.; Stanford, Carol; Walworth, Candace; Ward, Harry J.; Wiegmann, Thomas

doi:10.1001/archinte.165.8.936

Cited by 308 publications

(74 citation statements)

References 36 publications

(20 reference statements)

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“…Hydrochlorothiazide (HCT) is cheap antihypertensive drug proven to be effective in hypertension. 17 However, a study done in six low and middle income countries including Nepal observed that the median availability of HCT varied from 0 to 10%, 8 which is also reflected in our study. Unavailability of this cheap and effective medicine has two consequences.…”

Section: Medicine To Treat Ncds Constitute Minor Portion Ofsupporting

confidence: 50%

Variation in Price of Medicines and Free Medicine Availability for Treatment of Non-communicable Diseases in Public Sector of Eastern Nepal

Devkota

Paudel

Koirala

et al. 2018

J Nepal Health Res Council

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Background: Nepal is witnessing rise in non-communicable chronic diseases. Costs of the medicine, availability of the medicine for free in public health sectors and variation of price of medicines may play an important role in the management of chronic disease. The study was undertaken to find out the variation in price of drugs used for treating non communicable diseases among private pharmacies and availability of free essential medicines in public facilities.Methods: Randomly selected 33 public health centers and 13 pharmacies were included for the study. Availability of free essential medicines for treating selected chronic diseases was assessed in public health centers and percentage price variation in various branded drugs used for treating these diseases was assessed at the consumer level.Results: Out of 89 different formulations, variations between maximum and minimum priced brands of more than 100% were observed in 37 formulations and that of > 200% in 22 formulations. Thirty-seven formulations had more than 100% inter-pharmacy variation. The most commonly available free essential medicines was 4 mg salbutamol (88.57%) while the least available free essential drug was levothyroxine 5 mg (9.0%).Conclusions: Considerable variation in prices is seen among similar drugs and in prices of same drug in different pharmacies. These factors may have implications in the management of chronic disease in Nepal offsetting the government’s effort to control chronic diseases.

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Section: Medicine To Treat Ncds Constitute Minor Portion Ofsupporting

confidence: 50%

Variation in Price of Medicines and Free Medicine Availability for Treatment of Non-communicable Diseases in Public Sector of Eastern Nepal

Devkota

Paudel

Koirala

et al. 2018

J Nepal Health Res Council

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“…Thus, it is likely that the baseline CVD risk in AASK was lower than in high-risk populations without these exclusions. 6,8,15 Still, in participants with self-report of previous CVD, the rate of ESRD exceeded the rate of CVD mortality.…”

Section: ͻ0001mentioning

confidence: 94%

Rate of ESRD Exceeds Mortality among African Americans with Hypertensive Nephrosclerosis

Alves¹,

Wang²,

Wright³

et al. 2010

Journal of the American Society of Nephrology

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In several studies, patients with CKD seemed to be at greater risk for dying from cardiovascular disease (CVD) than reaching ESRD. The purpose of this study was to compare incident ESRD rates with rates of total mortality, CVD death, and a CVD composite (CVD mortality and CVD hospitalization) among participants who had hypertensive nephrosclerosis and were enrolled in the African American Study of Kidney Disease and Hypertension (AASK). The study period included the AASK trial phase (1996 through 2001) and a subsequent cohort phase (2002 through 2007). The AASK enrolled 1094 participants. Of the 764 participants who completed the trial phase without an event, 691 (90%) enrolled in the cohort phase. During 11 years of follow-up, there were 59 CVD-related deaths and 118 non-CVD-related deaths. The rate of ESRD (3.9/100 patient-years) was significantly higher than the rates of total mortality (2.2/100 patient-years), CVD mortality (0.8/100 patient-years), and the CVD composite (3.2/100 patient-years). The incidence rate ratio of ESRD to CVD mortality was 5.0. The rate of ESRD consistently exceeded the various mortality rates across most of the subgroups defined by age, gender, income, education, previous CVD, baseline urine protein excretion, and baseline estimated GFR. In conclusion, AASK participants were more likely to reach ESRD than to die.

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“…3,8-10, 37,44 In hypertensive diabetic patients with macroalbuminuria and renal insufficiency, ACE inhibitors and ARBs slow progression to end-stage renal disease (ESRD) by ~ 25% compared to other antihypertensive agents; this renoprotective effect may be lost or muted as renal failure progresses and serum creatinine rises to > 3.0 mg/dl. 3 An abrupt decline in renal function or a significant increase in serum potassium may occur in patients with renal insufficiency treated with these agents, and frequent monitoring (1-2 weeks) of electrolytes and renal function is recommended after the initiation or upward titration of these drugs.…”

Section: Pharmacological Treatment Of Hypertension In Diabetesmentioning

confidence: 99%

Management of Hypertension in Diabetes

Stults¹,

Jones²

2006

Diabetes Spectrum

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In Brief Untreated or poorly controlled hypertension can significantly accelerate the development and progression of both the micro- and macrovascular complications of diabetes. Aggressive blood pressure control improves patient outcomes and reduces health care costs. Unfortunately, nearly two-thirds of people with diabetes do not have blood pressure readings within the target range. Effective antihypertensive regimens maximize nonpharmacological therapies, minimize adverse effects on glucose control, lessen the risk of medication-related side-effects, and provide adequate cardiac and renal protection.

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Renal Outcomes in High-Risk Hypertensive Patients Treated With an Angiotensin-Converting Enzyme Inhibitor or a Calcium Channel Blocker vs a Diuretic

Cited by 308 publications

References 36 publications

Variation in Price of Medicines and Free Medicine Availability for Treatment of Non-communicable Diseases in Public Sector of Eastern Nepal

Variation in Price of Medicines and Free Medicine Availability for Treatment of Non-communicable Diseases in Public Sector of Eastern Nepal

Rate of ESRD Exceeds Mortality among African Americans with Hypertensive Nephrosclerosis

Management of Hypertension in Diabetes

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