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Factors associated with intensification of antihypertensive drug therapy in patients with poorly controlled hypertension.

ABSTRACT: Objective:To assess antihypertensive management of older patients with poor blood pressure (BP) control. Methods:Physicians, voluntary participating in the study, included six consecutive hypertensive patients during routine visits. Hypertension had to have been previously recognized and averaged office BP was ? 140 and/or ? 90 mmHg in spite of ? 6 weeks of antihypertensive therapy. The physicians completed a questionnaire on patients' history of cardiovascular (CV) risk factors, comorbidities, home BP monitoring, anthropometric data and the pharmacotherapy. Results:Mean age of the 6462 patients was 61 years, 7% were ? 80 years, 51% were female. Mean ± SD office BP values were 158 ± 13/92 ± 10 mmHg. The most commonly prescribed antihypertensive drugs were: diuretics (67%), ACE inhibitors (64%), calcium channel blockers (58%) and ?-blockers (54%), and their use increased with age. On monotherapy or dual therapy, 43% of the patients and 40% had their latest treatment modification within six months. Home BP monitoring was a factor that accelerated the modification of the therapy. Older patients had to have less chance on faster modification of antihypertensive therapy in spite of presence of diabetes and higher systolic BP. Conclusions:Our study suggests that a large number of outpatients with poor BP control receive suboptimal antihypertensive therapy, especially in primary care. In older patients, higher BP values in the office settings are more frequently accepted by physicians even in case of higher CV risk. Regular home BP monitoring hastens the decision to intensify of antihypertensive treatment.

SUBMITTER: Siga O

PROVIDER: S-EPMC6379243 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Factors associated with intensification of antihypertensive drug therapy in patients with poorly controlled hypertension.

Siga Olga O Wizner Barbara B Gryglewska Barbara B Walczewska Jolanta J Grodzicki Tomasz T

Journal of geriatric cardiology : JGC 20190101 1

<h4>Objective</h4>To assess antihypertensive management of older patients with poor blood pressure (BP) control.<h4>Methods</h4>Physicians, voluntary participating in the study, included six consecutive hypertensive patients during routine visits. Hypertension had to have been previously recognized and averaged office BP was ≥ 140 and/or ≥ 90 mmHg in spite of ≥ 6 weeks of antihypertensive therapy. The physicians completed a questionnaire on patients' history of cardiovascular (CV) risk factors, ...[more]

PMID: 30800147

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Project description:Hypertension is a major risk factor for cardiovascular disease, which is the leading cause of premature mortality and morbidity globally. Despite the evidences of the availability of effective treatment for hypertension, its management remains suboptimal. Medication adherence is the most crucial factor for blood pressure control. It is important to identify the factors associated with adherence to antihypertensive treatment for better management. Hence, this study assessed the level of antihypertensive medication adherence and its associated factors among patients with hypertension visiting a tertiary-level hospital in Kathmandu, Nepal. An analytical cross-sectional study was carried out among 308 diagnosed patients with hypertension who were prescribed antihypertensive medication. The Morisky Medication Adherence Scale (MMAS-8) was used to assess medication adherence. Data was collected through face-to-face interviews and analysed using SPSS v26. A bivariate and multivariate logistic regression model was used to assess the factors associated with low medication adherence. More than half (61%) of the study participants had moderate to high levels of medication adherence. Upon bivariate analysis, there was a significant association between presence of side effects, blood pressure status, forgetfulness, high cost, fear of taking medicine lifelong and irregular follow-up with a low level of adherence. Upon multivariate the logistic regression analysis, forgetfulness [Adjusted Odd's Ratio (AOR) 22.5, 95% Confidence Interval(CI) 10.56-47.86], high cost (AOR 3.8, 95%CI 1.25-11.60) and fear of taking medicines lifelong (AOR 6.04, 95%CI 2.96-12.33) were found to be associated factors of low level of adherence. There is an urgency to develop evidence-based strategies to improve the level of adherence to antihypertensive medications among patients with hypertension. Strategies like reminder messaging, setting alarms, expanding the scope of national health insurance and proper counselling to reduce fear could help to improve medication adherence. Hence, the feasibility and effectiveness of such intervention should be explored in future studies.

Project description:Patient empowerment through pharmacological self-management is a common strategy in some chronic diseases such as diabetes, but it is rarely used for controlling blood pressure. This study aimed to assess self-monitoring plus self-titration of antihypertensive medication versus usual care for reducing systolic blood pressure (SBP) at 12 months in poorly controlled hypertensive patients. The ADAMPA study was a pragmatic, controlled, randomized, non-masked clinical trial with two parallel arms in Valencia, Spain. Hypertensive patients older than 40 years, with SBP over 145 mmHg and/or diastolic blood pressure (DBP) over 90 mmHg, were recruited from July 2017 to June 2018. Participants were randomized 1:1 to usual care versus an individualized, pre-arranged plan based on self-monitoring plus self-titration. The primary outcome was the adjusted mean difference (AMD) in SBP between groups at 12 months. Primary outcome data were available for 312 patients (intervention n=156, control n=156) of the 366 who were initially recruited. The AMD in SBP at 12 months (main analysis) was -2.9 mmHg (95% CI, -5.9 to 0.1, p=0.061), while the AMD in DBP was -1.9 mmHg (95% CI, -3.7 to 0.0, p=0.052). The results of the subgroup analysis were consistent with these for the main outcome measures. More patients in the intervention group achieved good blood pressure control (<140/90 mmHg) at 12 months than in the control group (55.8% vs 42.3%, difference 13.5%, 95% CI, 2.5 to 24.5%, p=0.017). At 12 months, no differences were observed in behavior, quality of life, use of health services, or adverse events. Self-monitoring plus self-titration of antihypertensive medication based on an individualized pre-arranged plan used in primary care may be a promising strategy for reducing blood pressure at 12 months compared to usual care, without increasing healthcare utilization or adverse events. EudraCT, number 2016-003986-25 (registered 17 March 2017) and clinicaltrials.gov , NCT03242785.

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Factors associated with intensification of antihypertensive drug therapy in patients with poorly controlled hypertension.

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Factors associated with intensification of antihypertensive drug therapy in patients with poorly controlled hypertension.

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