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Introduction: The increasing prevalence of hypertension isattributed to population growth, ageing and behavioural riskfactors, such as unhealthy diet, harmful use of alcohol, lackof physical activity, excess weight and exposure to persistentstress. The present study was conducted to study on variousfacets of antihypertensive drugs prescribing at present scenarioat Dr B.C. Roy Hospital, Haldia, and with objectives of studyingprescribing patterns and rationality of antihypertensive drugsin essential hypertension with or without specific co-morbidconditions and to check compliance of treatment as per JNC-8hypertension treatment guidelines in the outpatients attendingthe Department of Medicine.Material and Methods: Data regarding anti-HTN monotherapy and combination therapy was recorded. Evaluation forrational drug therapy by evaluating average number of drugsper prescription, fixed dose combination (FDC) prescriptionrate, prescription laying down importance of lifestylemanagement, prescription with defined anti-HTN goals,prescriptions with correct dose strength and dosage schedulewas evaluated.Results: Out of 100 hypertensive patients under evaluation 67was males (67%) with a M:F ratio of 2.03:1. Mean SBP wasslightly higher in male patients. Hypertension was classifiedaccording to JNC-8 guidelines and found 22 (22%) (Prehypertension/pre-HTN), 57 (57%) (Stage 1 hypertension),and 13% (stage 2 hypertension) cases. Dyslipidemia wasnoted much more common associated disorders among newlydiagnosed hypertensive of either sex.Conclusion: Diuretics (8%) were most widely prescribeddrugs followed by ARBs (6%), ACE Inhibitors (5%) andcalcium channel blockers (4%) as monotherapy. Adherence ofJNC 8 guidelines among all study hypertensive participantswhile prescribing medications varied between 62% to 92%,with an average of 75%. None of the prescriptions mentionedban drug formulation(s). Still 15% of the prescriptionshad suggested combined drugs with debated rationalityformulations.
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FDA issued Guidance for Industry Hypertension Indication:Drug Labeling for Cardiovascular Outcome Claims in March 2017,requires that antihypertensive drug labeling should increase the content that lowering blood pressure can prevent serious cardiovascular events,provide a standard description of the INDICATIONS AND USAGE and CLINICAL STUDIES section in labeling in detail.The aim is to encourage the rational use of antihypertensive drugs in hypertensive patients,to reduce blood pressure to the target level,and to improve the outcomes.This paper introduces the main contents of guidance and enumerates a example,and look forward to that antihypertensive drug manufacturers and drug regulatory authorities can learn from this practice of FDA,and work together to revise antihypertensive drug labeling as soon as possible in our country,so as to benefit patients.
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OBJECTIVE:To investigate the effects of 3 types of antihypertensive drugs on cognitive function in elderly hyper-tensive patients after acetabular surgery. METHODS:Ninety hypertensive patients receiving antihypertensive drugs for a long term (not changed antihypertensive drugs within 2 weeks before surgery)undergoing selective acetabular surgery were included sequen-tially and divided into angiotensin receptor blocker(ARB)group,angiotensin converting enzyme inhibitor(ACEI)group and cal-cium channel blocker(CCB)group according to the types of antihypertensive drugs,with 30 cases in each group. All patients re-ceived acetabular surgery under epidural anesthesia. The cognitive function of patients was evaluated by using MMSE 1 d before sur-gery(T0),1 d after surgery(T2)and 3 d after surgery(T3). The concentration of S100β protein serum was determined 1d before surgery (T0),immediately after surgery (T1) and 1 d after surgery (T2). RESULTS:Compared with T0,MMSE score of ARB group at T2,those of ACEI group and CCB group at T2 and T3 were decreased significantly,with statistical significance(P<0.05). Compared with ARB group,MMSE score of ACEI group and CCB group at T2,T3 were decreased significantly,with statistical sig-nificance(P<0.05). Compared with ACEI group,MMSE score of CCB group at T2,T3 were decreased significantly,with statisti-cal significance(P<0.05). Compared with T0,the concentration of S100β protein in serum 3 groups were increased significantly, with statistical significance (P<0.05). Compared with ARB group,the concentration of S100β protein serum in ACEI group and CCB group were increased significantly,with statistical significance(P<0.05). Compared with ACEI group,the concentration of S100β protein serum in CCB group at T1,T2 were increased significantly,with statistical significance(P<0.05). The incidence of cognitive dysfunction was in ascending order of ARB group (30%)
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FDA issued Guidance for Industry Hypertension Indication:Drug Labeling for Cardiovascular Outcome Claims in March 2017,requires that antihypertensive drug labeling should increase the content that lowering blood pressure can prevent serious cardiovascular events,provide a standard description of the INDICATIONS AND USAGE and CLINICAL STUDIES section in labeling in detail.The aim is to encourage the rational use of antihypertensive drugs in hypertensive patients,to reduce blood pressure to the target level,and to improve the outcomes.This paper introduces the main contents of guidance and enumerates a example,and look forward to that antihypertensive drug manufacturers and drug regulatory authorities can learn from this practice of FDA,and work together to revise antihypertensive drug labeling as soon as possible in our country,so as to benefit patients.
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Objective To study the application of outpatient oral antihypertensive drugs in Shanghai Meishan Hospital, and provide a guide for clinical rational drug use.Methods The utilization of antihypertensive drugs in outpatients of our hos-pital was analyzed statistically by using defined daily dose (DDD) recommended by WHO.Results ① The most commonly used antihypertensive drugs in outpatients was calcium antagonist (51.98% ), followed by angiotensin receptor blockers (16.60% ),fixed-dose combination (13.23% ),β-blockers (11.93% ),diuretics (3.67% ),angiotensin-converting enzyme in-hibitors (2.40% ),and α,β-blockers (0.19% ). ② The combination therapy was fewer in outpatients than monotherapy (32.99% versus 67.01% ).Conclusion The application of antihypertensive drugs is basically reasonable in outpatient of our hospital,but the combination therapy was inadequate.
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Objective To understand the compliance of antihypertensive drug use in patients with hypertension.Methods A retrospective analysis was conducted among 218 patients with hypertension to understand their drug use compliancy and influencing factors,including side effect of the drugs,drug type,educational level,economic status and drug use length.Results The factors including disease course,drug type,drug use length and drug side effects,the economy status,educational level,awareness of hypertension related knowledge and psychological reaction could significantly influence the compliance of antihypertensive drug use.Among the patients surveyed,86.67％ of them with poor drug use compliance had only an educational level less than senior high school,77.33％ had poor awareness of hypertension related knowledge.Conclusion The antihypertensive drug use compliance in patients with hypertension is directly related to the outcome of the disease in clinical treatment.It is necessary to take effective measures to improve the treatment compliance and maintain normal blood pressure level of the patients.
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OBJECTIVE:To understand the proportion of university faculty suffering from hypertension,and the regularity,ratio-nality and affordability of antihypertensive drugs under closed medical environment. METHODS:Empirical research and research methods were adopted to collect indicators during 2011-2014,such as average daily wage in Wuhan,the total number of staff in Wuhan University,the number of staff with hypertension,antihypertensive drugs amount/DDDs ranking ratio,affordability ratio,relative av-erage affordability, etc. The rationality and affordability of antihypertensive drug prices were evaluated. RESULTS:During 2011-2014,the prevalence rate of hypertension in the staff were about 23%,and the proportion increased year by year;the annual in-crease of antihypertensive drug amount was larger than that of the number of patients;the type of antihypertensive drugs with affordabil-ity ratio>1 in 4 years was ARB varieties,and affordability ratio of other drugs was less than 1. CONCLUSIONS:More than half of drugs is high in price,that result in heavy burden of patients receiving ARB;on the whole,antihypertensive drugs are affordable of the teaching staff of Wuhan University.
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Objective To discuss the clinical effect and influence combination of drugs on the functions of target organs in the patients with salt-sensitive hypertension.Methods 125 patients with salt-sensitive hypertension, their clinical data retrospec-tively analyzed, divided into two groups, treated with coaprovel and felodipine combined with irbesartan respectively for 8 weeks.The levels of left ventricular mass index (LVMI), fasting blood glucose (FBG), triglyceride (TC), total cholesterol (TC) and blood 2-microglobulin (2-MG) during the treatment were then observed.Results The amplitude of blood pressure was significantly lower in the coaprovel group after 4 weeks and 8 weeks of treatment in the patients with salt -sensitive hypertension.However, there was no statistical difference of effectiveness between the coaprovel group ( 81.0%) and the felodipine combined with irbesartan group (83.9%).The decrease range of LVMI showed significantly better results in the coaprovel group (28.9 ±7.3).Moreover, there was no statistical difference in other indexes between two groups or before and after treatment .Conclusion Coaprovel has a similar cura-tive effect with felodipine combined with irbesartan in the treatment of patients with salt -sensitive hypertension.It has more signifi-cant protective effect for heart damage .
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PURPOSE: The influence of dietary composition on blood pressure is an important subject in healthcare. Interactions between antihypertensive drugs and diet (IBADD) is the most important factor in the management of hypertension. It is therefore essential to support healthcare providers' decision making role in active and continuous interaction control in hypertension management. The aim of this study was to implement an ontology-based clinical decision support system (CDSS) for IBADD management (IBADDM). We considered the concepts of antihypertensive drugs and foods, and focused on the interchangeability between the database and the CDSS when providing tailored information. METHODS: An ontology-based CDSS for IBADDM was implemented in eight phases: (1) determining the domain and scope of ontology, (2) reviewing existing ontology, (3) extracting and defining the concepts, (4) assigning relationships between concepts, (5) creating a conceptual map with CmapTools, (6) selecting upper ontology, (7) formally representing the ontology with Protege (ver.4.3), (8) implementing an ontology-based CDSS as a JAVA prototype application. RESULTS: We extracted 5,926 concepts, 15 properties, and formally represented them using Protege. An ontology-based CDSS for IBADDM was implemented and the evaluation score was 4.60 out of 5. CONCLUSION: We endeavored to map functions of a CDSS and implement an ontology-based CDSS for IBADDM.
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Humans , Antihypertensive Agents/therapeutic use , Biological Ontologies , Databases, Factual , Decision Support Systems, Clinical , Diet , Drug Interactions , Hypertension/drug therapy , SoftwareABSTRACT
In this article, we provide a brief summary of study design of case-control study within a cohort and an introduction of two case-control studies within a cohort conducted in Japan recently using antihypertensive drug database based on the post-marketing surveillance data of pharmaceutical companies. In the case-control study within a cohort, it is possible to avoid bias caused in a case-control study and conduct more efficiently than cohort study. Therefore the case-control study within a cohort widely has been used in pharmacoepidemiological studies with a database. (Jpn J Pharmacoepidemiol 2013; 18(2): 77-83)
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OBJECTIVE:To provide references for clinicians in the choice of antihypertensive drugs.METHODS:The antihypertensive efficacy 6 classes(or 15 kinds) of antihypertensive drugs in a monotherapy in the treatment of 370 patients with essential hypertension(EH) were compared.RESULTS:The blood pressure was effectively lowered by all of the antihypertensive drugs except doxazosin,and doxazosin and torasemide showed inferior efficacy in the reduction of diastolic blood pressure(DBP).CONCLUSION:Calcium antagonists with prolonged action,angiotensin converting enzyme inhibitor(ACEI),angiotens-in receptor antagonist,and the monotherapy of Terazosin or Indapamide can all effectively bring down the blood pressure.It is suggested that low-dose doxazosin and torasemide should not be used alone in treating essential hypertension.
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OBJECTIVE: To discuss the development of the antihypertensive drugs in China. METHODS: The varieties of antihypertensive drugs in New Materia Medica from the 11th (1981) to 16th edition (2007) were analyzed statistically. RESULTS & CONCLUSIONS: The antihypertensive drugs in China has experienced a great development ever since 1997 (14th edition) in that the varieties of adrenoreceptor blockers, calcium-channel blocker, angiotensin-converting enzyme inhibitors and Ang Ⅱ receptor blockers had been increased, thus safer and more effective drugs were available for hypertensive patients meanwhile the case fatality was able to be reduced.
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The study was carried out on 39 patients who had hypertension of degree I, II, with lipidemia but without complications to investigate lipoproteins HDL-C, LDL-C of them. The results showed that: concentration of HDL-C increased by 12.5%, concentration of LDL-C decreased by 12.9% (p<0.001) after 30 days of treatment with antihypertensive herbal remedy Nguu tat, Hoe nhai, Linh chi. The results indicated that the remedy had good effects and reduced risk factors of atherosclerosis and hyperlipaemia
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Hypertension , LipoproteinsABSTRACT
Aggressive treatment of hypertension has been proved to reduce morbidity and mortality. Data from recent clinical trials indicate that, for all stages of hypertension, the target BP should be a maximum BP <140/90 mmHg, with diastolic BP values as low as 70 mmHg. For patients with diabetes mellitus or chronic renal disease, this target value should be even lower, <130/80 mmHg. As significant morbidity and mortality attributable to hypertension occur in patients who are not diagnosed as having hypertension but whose blood pressure is in prehypertension range, 120~139/80~89 mmHg, lowering BP levels in this group is recommended as well, with lifestyle modification or drug therapy for some indicated patients being first-line therapy. Because controlling BP to <140/90 mmHg often requires use of two or more agents, selection of drugs for combination therapy should be based not only on antihypertensive efficacy, but also on compelling indications and tolerability of the regimens. This review presents the latest findings on the antihypertensive therapy and emphasizes the importance of decreasing BP per the JNC-7 guidelines.
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Humans , Blood Pressure , Diabetes Mellitus , Drug Therapy , Hypertension , Life Style , Mortality , Prehypertension , Renal Insufficiency, ChronicABSTRACT
In order to achieve high quality antihypertensive effect.It's necessary to develop new antihypertensive drugs.This paper expounds new antihypertensive medications,including the mechanism of action,the drug characteristics and representatives of new antihypertensive medications,such as selective aldosterone receptor antagonist,D1 receptor agonist,endopeptidase-angiotensin converting enzyme inhibitor,renin inhibitor,endothelin receptor blockers,potassium channel opener,nitrogen monoxidum,T-calcium channel blockers.Hypertension is a polygenic inheritance disease and gene therapy is a hot spot of currently hypertension treatment research.This paper introduces the research progress of gene therapy of hypertension.
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Hypertension control is the most important and effective treatment for chronic kidney diseases.Compared with hypertension patients without kidney diseases,it requires a stricter blood pressure control in those with kidney diseases.The treatment principles are:(i)To lower the blood pressure is the top priority;and(ii)the impacts of various antihypertensive drugs on individual patients.The antihypertensive drugs should be chosen taking into consideration of the following factors:the extent of hypertension,whether the hypertension occurs abruptly or permanently,the heart and renal functions and any significant metabolic disorders.Among the existing drugs,diuretic is usually hampered by renal dysfunction;ACEI/ARB seems to be more effective on patients with proteinuria,but it should be used with caution in patients with severe renal insufficiency;CCB is effective and can quickly lower blood pressure,therefore it is an essential drug for hypertension treatment;?-blocker is not considered as a main drug for hypertension with kidney diseases.Combination use of anti-hypertensive drug is common to many CKD with hypertension,among them ACEI/ARB+diuretic,ACEI/ARG+CCB are the most common combinations.ACEI+ARB exhibit a better proteinuria reduction effect;however it is not indicated in patients with severe cardiovascular lesion.Hypertension treatment should take into consideration of individual differences and should be adjusted according to individual responses.Salt intake control also plays an important role in the successful treatment of hypertension with kidney diseases.
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Objective : To examine whether drug treatment for hypertension prevents the first occurrence of cerebral hemorrhage, a population-based case-control study was conducted in Hirara-city, Okinawa Prefecture, Japan.<BR>Methods : Cases were 36 hypertensive persons, 45 to 84 years of age, who had experienced cerebral hemorrhage from 1991 to 1994. Twenty of them were ascertained to be hypertensive by residential mass health examinations before the occurrence of cerebral hemorrhage, and other cases were ascertained by stroke register. Controls were 158 hypertensive persons unaffected by stroke and other life-threatening diseases, who were matched with their corresponding case for sex, age and mean blood pressure. All controls were ascertained as hypertensive by health examinations in 1991. Data on antihypertensive treatment, during the two years before the occurrence for cases and between April 1992 and March 1994 for controls, were collected by claims for medical care cost and medical records. Conditional logistic regression was employed for matched analyses.<BR>Results : Regarding treatment, 16 (44.4%) cases and 36 (23.5%) controls did not receive antihypertensive drug treatment, and 13 (36.1%) cases and 30 (19.6%) controls had interrupted treatment. Compared with continuously treated persons, untreated persons and interrupted persons had odds ratios of 6.27 (95% confidence interval : 2.21 to 17.8) and 4.94 (1.79 to 13.6) for cerebral hemorrhage, respectively. Cases were prescribed antihypertensive drugs for fewer months than controls. By subgroup analyses limited to the cases ascertained as hypertensive by mass health examinations and their matched controls, the same relation was observed.<BR>Conclusion : Among hypertensive persons, non-treatment and interruption of antihypertensive drug treatment were associated with a higher risk of cerebral hemorrhage. Long-term continuous treatment with antihypertensive drug (s) prevents the first occurrence of cerebral hemorrhage.
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BACKGROUND AND METHODS: In order to evaluate characteristics and modulatory factors of blood pressure in peritoneal dialysis(PD), studies were conducted on the 69 patients who had underwent peritoneal equilibration test(PET). RESULTS: The results were as follows: 1) All patients received an antihypertensive drug before PD, but, 15 of 69 patients successfully quit taking the antihypertensive drug after peritoneal dialysis. 2) During peritoneal dialysis, mean arterial pressure(MAP) was significantlydecreased for the first 3 months, and this lasted for 1 year, and antihypertensive drug requirements were significantly decreased continuously up to 9 months(p<0.005). 3) After changing the modality from hemodialysis to peritoneal dialysis. MAP(mmHg, from 107.1+/-4.5 to 98.6+/-8.8, p<0.05), antihypertensive drug requirements(from 5.6+/-2.6, to 2.0+/-2.5, p<0.01) and erythropoietin dosages(Uint/week, from 4600+/-2660 to 2000+/-1630, p<0.05) were decreased. 4) Multiple logistic regression analysis showed that MAP(p<0.01) and daily ultrafiltration volume(p<0.05) can contribute to the determination of antihypertensive drug requirements. However the relationship between antihypertensive drug requirements and PET results or dialysis adequacy indices(weekly Kt/V. weekly creatinine clearance) was not revealed. CONCLUSION: In conclusion, the prescription of antihypertensive drugs should be considered according to daily ultrafiltration volume, especially during first year after initiating PD, and follow-ups for over a year may be needed.
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Humans , Antihypertensive Agents , Blood Pressure , Creatinine , Dialysis , Erythropoietin , Follow-Up Studies , Kidney Failure, Chronic , Logistic Models , Peritoneal Dialysis , Prescriptions , Renal Dialysis , UltrafiltrationABSTRACT
AIM: To investigate the clinical utilization of antihypertension agents in a hospital. METHODS: By the method of retrospective study, 301 medical records (286 was selected) of discharged patients with hypertension who were admitted from June 2003 to June 2004 were investigated. RESULTS: The angiotensin converting enzyme inhibitors (ACEI) and calcium antagonists were used with the highest frequency, and the use frequency from high to low listed as enalapril, metoprolol, felodipine, benazapril and losartan. All drugs were administrated in combined therapy. CONCLUSION: The usage of antihypertensive drugs is rational in this hospital, and the tendency of drug utilization is similar to international standard.
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Melanosis duodeni is an uncommon pathologic condition characterized by diffuse small black spots on the first and second portions of the duodenum. It occurs predominantly in elderly patients and is linked to chronic renal failure, use of antihypertensive drug and oral iron supplementation, and/or presence of gastric hemorrhage. We report a case of melanosis duodeni in a 60-year-old woman diagnosed with hypertension 20 years ago and chronic renal failure 6 years ago. She has taken antihypertensive drugs for many years. On endoscopy, speckled black pigmentation of duodenal mucosa was detected. Microscopically, this duodenal lesions showed numerous coarse pigments in macrophages confined within the lamina propria. By ultrastructural study, macrophages contained electron-dense granules admixed with lipofuscin-like material in residual bodies.