scholarly journals Analysis of Recent Papers in Hypertension Initial Combination Therapy Provides More Prompt Blood Pressure Control and Reduces Cardiovascular Events But Remains Underutilized

2013 ◽  
Vol 15 (8) ◽  
pp. 523-525 ◽  
Author(s):  
Jan N. Basile ◽  
Michael J. Bloch
Keyword(s):  
Blood Pressure ◽  
Combination Therapy ◽  
Blood Pressure Control ◽  
Cardiovascular Events ◽  
Pressure Control ◽  
Initial Combination Therapy ◽  
Initial Combination

scholarly journals Evening anti-hypertensive dosing improves blood pressure control and reduce cardiovascular events in hypertensive: a meta-analysis of 40 trials in 44,167 patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.P Sunjaya ◽  
A.F Sunjaya
Keyword(s):  
Blood Pressure ◽  
Randomized Controlled Trials ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Control ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Pressure Control ◽  
Controlled Trials ◽  
Night Time ◽  
Randomized Controlled

Abstract Introduction Nocturnal blood pressure (BP) and early morning BP surge have consistently been found to be a better prognostic marker of cardiovascular outcome than daytime BP. Most anti-hypertensive show greater blood pressure-lowering effect in the first 12 hours compared to the next 12 hours. Several prospective studies have shown better BP regulation and improved cardiovascular risk when anti-hypertensive are ingested at bedtime versus at awakening. Purpose In patients with hypertension does evening dosing of anti-hypertensive compared to morning dosing led to better reduction in pressure, blood pressure control and reduced cardiovascular morbidity. Methods A meta-analysis was performed based on randomized controlled trials obtained from Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline and Medline ahead of print published between 2000 and 2020. Main outcome measures include mean 24 hour systolic and diastolic blood pressure, cardiovascular events as well as prevalence of blood pressure in control. Data synthesis and analysis was done using RevMan 5.3 using a random effects model. Results A total of 40 randomized controlled trials, representing 44,167 patients were included in this meta-analysis. Most studies evaluate the administration of mixed anti-hypertensive with ≥1 medication ingested at bedtime, calcium channel blockers (CCBs) or angiotensin receptor blockers (ARBs) with sample sizes ranging from 30 to 19,084 patients. Evening administration of anti-hypertensive was found to significantly lower 24-hour systolic blood pressure (Mean difference = −1.05, 95% CI: −2.01 to −0.10, p=0.03) and 24-hour diastolic blood pressure (Mean difference = −1.09, 95% CI: −1.68 to −0.50, p=0.0003). Prevalence of controlled blood pressure was found to significantly increase with evening dosing (RR=1.15, 95% CI: 1.03 to 1.28, p=0.01). Significant reduction in cardiovascular events were found in the evening dosing group (RR=0.48, 95% CI: 0.03 to 0.68, p=<0.00001). Discussion Reduction in night-time blood pressure especially among non-dippers as reported in previous studies and higher prevalence of controlled blood pressure may explain the greater than 50% reduction in cardiovascular events in the evening dosing group. This marked benefit from a simple and inexpensive strategy certainly has great potential to benefit patients in practice. Even so, few studies have reported the prevalence of blood pressure in control (9 studies) and cardiovascular events (6 studies). Few has also studied this in geriatric populations where night-time hypotension and hypoperfusion may bring the most impact. Conclusion For patients with hypertension, evening dosing significantly improves blood pressure control and reduces the risk for cardiovascular events. Careful selection of anti-hypertensive administration time in patients is recommended given the possible benefits. Anti Hypertensive Dosing Forest Plot Funding Acknowledgement Type of funding source: None

scholarly journals Drug utilization study of antihypertensive drugs and prevalence of blood pressure control in adult hypertensive patients based on JNC VIII guidelines in a tertiary care hospital: a cross sectional study

2019 ◽  
Vol 8 (2) ◽  
pp. 245
Author(s):  
Saumya Ramadas ◽  
M. B. Sujatha ◽  
M. A. Andrews ◽  
Sanalkumar K. B.
Keyword(s):  
Blood Pressure ◽  
Combination Therapy ◽  
Drug Utilization ◽  
Antihypertensive Drug ◽  
Blood Pressure Control ◽  
Antihypertensive Drugs ◽  
Pressure Control ◽  
Antihypertensive Drug Therapy ◽  
Care Hospital ◽  
Drug Utilization Study

Background: Hypertension is a major independent risk factor for coronary artery disease, congestive heart failure, stroke, chronic kidney disease and peripheral vascular diseases if left untreated. Drug utilization study of antihypertensive drugs and the study on prevalence of blood pressure control would help in reducing the burden of the disease and health expenditure.Methods: The study was conducted in the Outpatient Department of Medicine in Government Medical College, Thrissur. Patients aged 18yrs or above diagnosed with hypertension, on antihypertensive drugs were enrolled in the study. Patients suffering from secondary hypertension and acutely ill were excluded. Patients were enrolled after taking an informed consent. Demographic data, present treatment for hypertension, associated co- morbid conditions if any, and treatment of the same were recorded. BP was recorded, and cost of treatment was calculated using CIMS.Results: A total of 250 patients were included in the study. Mono therapy was used in 64.8% patients and combination therapy in 35.2%. Overall drug utilization pattern showed that CCBs (42.8%) were most commonly prescribed, followed by ACEIs (32.4%) and ARBs (29.2%). Most commonly prescribed combination therapy was ACE I + BB (29.3%), followed by ARB + CCB (21.3%). Mean cost of antihypertensive drug therapy was 3057.8 Rs / yr. Recommended target BP was achieved in 49.6% of patients.Conclusions: The prescription pattern of antihypertensive drug was in accordance to the JNC-VIII guidelines. The blood pressure target was achieved only in less than 50% of patients.

Risk of Cardiovascular Events and Blood Pressure Control in Hypertensive HIV-Infected Patients

2013 ◽  
Vol 62 (4) ◽  
pp. 396-404 ◽  
Author(s):  
Reto Nüesch ◽  
Qing Wang ◽  
Luigia Elzi ◽  
Enos Bernasconi ◽  
Rainer Weber ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Cardiovascular Events ◽  
Pressure Control
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