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Antihypertensive drugs guidelines

Arshag D Mooradian
The number of older adults with diabetes is rapidly increasing worldwide. A variety of factors contribute to the age-related increase in the incidence of diabetes. The lack of empiric evidence in the field has limited the management guidelines to mostly expert opinion. Given uncertainty over the rate at which to lower blood glucose levels and the optimal method of doing so, the goals of diabetes control in older people must be individualized. If the patient requires insulin therapy, the newer insulins, with their improved pharmacodynamic consistency and reduced risk of hypoglycemia, should be preferred...
October 10, 2018: Drugs & Aging
Brent Egan, John Flack, Mehul Patel, Sofia Lombera
A quantitative survey was completed by 103 primary care physicians (PCPs) and 59 cardiologists who regularly prescribed β-blockers to assess knowledge and use of this heterogeneous drug class for hypertension. More cardiologists than PCPs chose β-blockers as initial antihypertensive therapy (30% vs 17%, P < 0.01). Metoprolol and carvedilol were the most commonly prescribed β-blockers. Cardiologists rated "impact on energy" and "arterial vasodilation" as more important than PCPs (P < 0...
October 2018: Journal of Clinical Hypertension
N P Bowles, S S Thosar, M X Herzig, S A Shea
PURPOSE OF REVIEW: Given the emerging knowledge that circadian rhythmicity exists in every cell and all organ systems, there is increasing interest in the possible benefits of chronotherapy for many diseases. There is a well-documented 24-h pattern of blood pressure with a morning surge that may contribute to the observed morning increase in adverse cardiovascular events. Historically, antihypertensive therapy involves morning doses, usually aimed at reducing daytime blood pressure surges, but an absence of nocturnal dipping blood pressure is also associated with increased cardiovascular risk...
September 28, 2018: Current Hypertension Reports
Jens Jordan, Christine Kurschat, Hannes Reuter
BACKGROUND: Essential arterial hypertension is one of the main treatable cardiovascular risk factors. In Germany, approximately 13% of women and 18% of men have uncontrolled high blood pressure (≥ 140/90 mmHg). METHODS: This review is based on pertinent publications retrieved by a selective literature search in PubMed. RESULTS: Arterial hypertension is diagnosed when repeated measurements in a doctor's office yield values of 140/90 mmHg or higher...
August 20, 2018: Deutsches Ärzteblatt International
Valeria Avataneo, Amedeo De Nicolò, Franco Rabbia, Mauro Sciandra, Francesco Tosello, Jessica Cusato, Elisa Perlo, Giovanna Fatiguso, Sarah Allegra, Fabio Favata, Paolo Mulatero, Franco Veglio, Giovanni Di Perri, Antonio D'Avolio
INTRODUCTION: Nowadays, the treatment of hypertension represents an important issue, particularly in developed countries. While in most cases the standard therapeutic approaches, consisting in the administration of 1 to 3 drugs, are adequate to reach adequate blood pressure levels, in some cases more drugs are needed: this condition is called "resistant hypertension". In this context, the administration of a diuretic, such as spironolactone or canrenoate salts, represents a standard practice...
August 28, 2018: Journal of Pharmacological and Toxicological Methods
Jared Davis, Suzanne Oparil
PURPOSE OF REVIEW: The purpose of this review is to summarize the most recent data available on advances in development of novel medical treatments for hypertension and related comorbidities. RECENT FINDINGS: Approximately half of all hypertensive patients have not achieved goal blood pressure with current available antihypertensive medications. Recent landmark studies and new hypertension guidelines have called for stricter blood pressure control, creating a need for better strategies for lowering blood pressure...
August 25, 2018: Current Hypertension Reports
Sajid Mahmood, Kifayat Ullah Shah, Tahir Mehmood Khan, Sarfraz Nawaz, Haroon Rashid, Syed Waqar Ali Baqar, Sohail Kamran
Hypertension is a major risk factor for a number of cardiovascular diseases. Proper management of hypertension may require both pharmacological and non-pharmacological interventions. Non-pharmacological interventions help reduce the daily dose of antihypertensive medication and delay the progression from prehypertension to hypertension stage. Non-pharmacological interventions include lifestyle modifications like dietary modifications, exercise, avoiding stress, and minimizing alcohol consumption. Nutritional requirements of hypertensive individuals can be addressed through adopting either the DASH diet or through traditional Mediterranean diet...
August 22, 2018: Irish Journal of Medical Science
Kirsten P J Smits, Grigory Sidorenkov, Nanne Kleefstra, Steven H Hendriks, Margriet Bouma, Marianne Meulepas, Gerjan Navis, Henk J G Bilo, Petra Denig
BACKGROUND: Guideline-adherent prescribing for treatment of multiple risk factors in type 2 diabetes (T2D) patients is expected to improve clinical outcomes. However, the relationship to Health-Related Quality of Life (HRQoL) is not straightforward since guideline-adherent prescribing can increase medication burden. OBJECTIVES: To test whether guideline-adherent prescribing and disease-specific medication burden are associated with HRQoL in patients with T2D. METHODS: Cross-sectional study including 1,044 T2D patients from the e-VitaDM/ZODIAC study in 2012 in the Netherlands...
2018: PloS One
Marianne A Mahrouse
Therapeutic drug monitoring of angiotensin converting enzyme inhibitors (ACEI) has a great impact in blood pressure control in patient with heart failure, hepatic and renal impairment. To provide an efficient tool for drug assessment in plasma, UPLC-MS/MS method was developed for simultaneous determination of benazepril hydrochloride (BNZ), fosinopril sodium (FOS), captopril (CAP) and hydrochlorothiazide (HCT) in human plasma samples. Solid phase extraction was applied for sample preparation using OASIS® hydrophilic-lipophilic balanced reversed phase sorbents cartridges...
August 14, 2018: Biomedical Chromatography: BMC
Bumjung Kim, Cheolmin Jo, Ho-Young Choi, Kyungjin Lee
Historically, traditional herbal medicines (THMs) have been the conventional treatment strategy in the Korean medical system for treating many diseases. However, THMs have rarely been used to treat hypertension, and moreover few studies have investigated the interaction of blood pressure with the coadministration of synthetic antihypertensives. We aimed to evaluate the vasorelaxant and hypotensive effects of the traditional herbal prescription Cheonwangbosimdan (CWBSD; "Tianwangbuxindan" in Chinese) and the combination of CWBSD with amlodipine...
2018: Evidence-based Complementary and Alternative Medicine: ECAM
Nanny N M Soetedjo, Susan M McAllister, Cesar Ugarte-Gil, Adela G Firanescu, Katharina Ronacher, Bachti Alisjahbana, Anca L Costache, Carlos Zubiate, Stephanus T Malherbe, Raspati C Koesoemadinata, Yoko V Laurence, Fiona Pearson, Sarah Kerry-Barnard, Rovina Ruslami, David A J Moore, Mihai Ioana, Leanie Kleynhans, Hikmat Permana, Philip C Hill, Maria Mota, Gerhard Walzl, Hazel M Dockrell, Julia A Critchley, Reinout van Crevel
OBJECTIVE: To describe the characteristics and management of Diabetes mellitus (DM) patients from low- and middle-income countries (LMIC). METHODS: We systematically characterised consecutive DM patients attending public health services in urban settings in Indonesia, Peru, Romania and South Africa, collecting data on DM treatment history, complications, drug treatment, obesity, HbA1c and cardiovascular risk profile; and assessing treatment gaps against relevant national guidelines...
October 2018: Tropical Medicine & International Health: TM & IH
Randall S Stafford
The recently released 2017 High Blood Pressure Guidelines depart from past guidelines in both their approach and recommendations. Developed by multiple health organizations, including the American College of Preventive Medicine, the guidelines continue to define normal blood pressure as <120/80 mmHg, but now define hypertension as ≥130/80 mmHg (previously ≥140/90 mmHg). This change categorizes 101 million Americans (46% of adults) as hypertensive (compared to 32% previously). The guidelines rely heavily on findings from the Systolic Blood Pressure Intervention Trial (SPRINT)...
August 6, 2018: American Journal of Preventive Medicine
Omar Mukhtar, Joseph Cheriyan, John R Cockcroft, David Collier, James M Coulson, Indranil Dasgupta, Luca Faconti, Mark Glover, Anthony M Heagerty, Teck K Khong, Gregory Y H Lip, Adrian P Mander, Mellone N Marchong, Una Martin, Barry J McDonnell, Carmel M McEniery, Sandosh Padmanabhan, Manish Saxena, Peter J Sever, Julian I Shiel, Julie Wych, Phil J Chowienczyk, Ian B Wilkinson
BACKGROUND: Ethnicity, along with a variety of genetic and environmental factors, is thought to influence the efficacy of antihypertensive therapies. Current UK guidelines use a "black versus white" approach; in doing so, they ignore the United Kingdom's largest ethnic minority: Asians from South Asia. STUDY DESIGN: The primary purpose of the AIM-HY INFORM trial is to identify potential differences in response to antihypertensive drugs used as mono- or dual therapy on the basis of self-defined ethnicity...
May 20, 2018: American Heart Journal
Federico Rea, Giovanni Corrao, Luca Merlino, Giuseppe Mancia
Aims: Guidelines support use of drug combinations in most hypertensive patients, and recently treatment initiation with two drugs has been also recommended. However, limited evidence is available on whether this leads to greater cardiovascular (CV) protection compared to initial monotherapy. Methods and results: Using the healthcare utilization database of the Lombardy Region (Italy), the 44 534 residents of the region (age 40-80 years) who in 2010 started treatment with one antihypertensive drug (n = 37 078) or a two-drug fixed-dose combination (FDC, n = 7456) were followed for 1 year after treatment initiation to compare the risk of hospitalization for CV disease associated with the two treatment strategies...
July 27, 2018: European Heart Journal
Antonio Del Giudice, Andrea Fontana, Antonio Cicchella, Claudio Carmine Guida, Antonio Gesuete, Rachele Grifa, Antonio Mangiacotti, Filomena Miscio, Matteo Piemontese, Michele Prencipe, Michele Vergura, Massimiliano Copetti, Filippo Aucella
Objective: In developed countries, blood pressure (BP) control has increased over the past few decades and is now approaching 70% of patients. Herewith we report the results of a cross-sectional study carried out on hypertensive outpatients. Design and methods: In a cohort of 1,412 consecutive hypertensive outpatients (790 females, 622 males; mean age: 60.3±12.2 years) evaluated from January 2015 to December 2016, the following parameters were assessed: age, gender, body mass index (BMI), waist circumference (WC), smoking habits, BP in the sitting position, estimated glomerular filtration rate (eGFR), serum glucose, lipid profile, antihypertensive drugs prescribed...
July 2018: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Marta Kucan, Jasenka Mrsic-Pelcic, Dinko Vitezic
PURPOSE: Possible factors that could influence changes in patterns of prescribing antihypertensives could be identified by monitoring national trends in hypertension treatment. The choice of pharmacologic treatment in people with hypertension has important therapeutic and financial implications, due to the fact that the financial costs associated with hypertension continue to increase. The aims of our study were to identify and analyze changes in the usage of antihypertensive drugs in Croatia from 2000 to 2016 and to identify the changes in prescribing patterns as well as mean prices per defined daily dose (DDD)...
July 2018: Clinical Therapeutics
Rohan Khera, Yuan Lu, Jiapeng Lu, Anshul Saxena, Khurram Nasir, Lixin Jiang, Harlan M Krumholz
OBJECTIVE: To examine the effect of the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines on the prevalence of hypertension and eligibility for initiation and intensification of treatment in nationally representative populations from the United States and China. DESIGN: Observational assessment of nationally representative data. SETTING: US National Health and Nutrition Examination Survey (NHANES) for the most recent two cycles (2013-14, 2015-16) and China Health and Retirement Longitudinal Study (CHARLS) (2011-12)...
July 11, 2018: BMJ: British Medical Journal
Gennaro Russo, Ilaria Liguori, Luisa Aran, Giulia Bulli, Francesco Curcio, Gianluigi Galizia, Gaetano Gargiulo, Gianluca Testa, Andrea Ungar, Francesco Cacciatore, Domenico Bonaduce, Pasquale Abete
In the last years, guidelines for the treatment of hypertension recommended individualized blood pressure goals for geriatric population because of elderly susceptibility to adverse outcomes and higher mortality rate deriving from the excessive blood pressure lowering, especially in "frail" elderly. Recent findings from the SPRINT study, which demonstrated that intensive blood pressure lowering was associated with lower rates of cardiovascular events and mortality in both hypertensive fit and frail elderly subjects compared to standard treatment, heavily influenced the recent US guidelines...
September 2018: Journal of Human Hypertension
Melissa J Palmer, Sharmani Barnard, Pablo Perel, Caroline Free
BACKGROUND: Cardiovascular disease (CVD) is a major cause of disability and mortality globally. Premature fatal and non-fatal CVD is considered to be largely preventable through the control of risk factors via lifestyle modifications and preventive medication. Lipid-lowering and antihypertensive drug therapies for primary prevention are cost-effective in reducing CVD morbidity and mortality among high-risk people and are recommended by international guidelines. However, adherence to medication prescribed for the prevention of CVD can be poor...
June 22, 2018: Cochrane Database of Systematic Reviews
Christine Gulla, Elisabeth Flo, Reidun Ls Kjome, Bettina S Husebo
Background: It is debatable whether treating multimorbid nursing home patients with antihypertensive drugs produces beneficial effects. Most cardiovascular guidelines promote treatment; few have advice on how to deprescribe when treatment may no longer be necessary. We investigated the effect of medication review on antihypertensive drug use and the association between cognition, blood pressure, and prescribing. Methods: From August 2014 to December 2015, 765 patients from 72 units (clusters) in 32 Norwegian nursing homes were included in a 4-month, multicentre, cluster-randomized, controlled trial, with 9-month follow-up...
April 2018: Journal of Geriatric Cardiology: JGC
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