Difference in the Occurrence of Cardiovascular Events According to Class of Antihypertensive Agent, Based on a Follow-Up Study of Japanese Hypertension Patients (original) (raw)
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BMJ, 2010
Objective To examine the association of myocardial infarction and stroke incidence with several commonly used two drug antihypertensive treatment regimens. Design Population based case-control study. Setting Group Health Cooperative, Seattle, WA, USA. Participants Cases (n=353) were aged 30-79 years, had pharmacologically treated hypertension, and were diagnosed with a first fatal or non-fatal myocardial infarction or stroke between 1989 and 2005. Controls (n=952) were a random sample of Group Health members who had pharmacologically treated hypertension. We excluded individuals with heart failure, evidence of coronary heart disease, diabetes, or chronic kidney disease. Exposures One of three common two drug combinations: diuretics plus β blockers; diuretics plus calcium channel blockers; and diuretics plus angiotensin converting enzyme inhibitors or angiotensin receptor blockers. Main outcome measures Myocardial infarction or stroke. Results Compared with users of diuretics plus β blockers, users of diuretics plus calcium channel blockers had an increased risk of myocardial infarction (adjusted odds ratio (OR) 1.98, 95% confidence interval 1.37 to 2.87) but not of stroke (OR 1.02, 95% CI 0.63 to 1.64). The risks of myocardial infarction and stroke in users of diuretics plus angiotensin converting enzyme inhibitors or angiotensin receptor blockers were slightly but not significantly lower than in users of diuretics plus β blockers (myocardial infarction: OR 0.76, 95% CI 0.52 to 1.11; stroke: OR 0.71, 95% CI 0.46 to 1.10). Conclusions In patients with hypertension, diuretics plus calcium channel blockers were associated with a higher risk of myocardial infarction than other common two drug treatment regimens. A large trial of second line antihypertensive treatments in patients already on low dose diuretics is required to provide a solid basis for treatment recommendations.
The Journal of Clinical Hypertension, 2006
This national study examines the impact of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) on the prescribing of thiazide-type diuretics and other antihypertensive medications for patients with newly diagnosed hypertension. A cross-sectional analysis was conducted using data from a national network of electronic health records for 2 groups with newly diagnosed hypertension and started on antihypertensive medications: one a year before and the other a year after the publication of ALLHAT. The percentage of new hypertensives started on thiazides increased from 29% pre-ALLHAT to 39% post-ALLHAT. An increase was also seen for angiotensin receptor blockers, while prescribing for angiotensinconverting enzyme inhibitors, calcium channel blockers, and β-blockers declined. There was no significant change in prescriptions for α-blockers. ing practices. (J Clin Hypertens. 2006;8:860-864) al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903-1913 Cutler JA, MacMahon SW, Furberg CD. Controlled clinical trials of drug treatment for hypertension. A review.
Indian Research Journal of Pharmacy and Science, 2018
Background: Hypertension is the continuous increased arterial blood pressure. More than 25 antihypertensive agents are present for therapy according to patient factors. Administration of agents depends on the scale of therapy according to degree of hypertension. Aim: To follow up the model use of antihypertensive agents in hypertensive Jordanian subjects for hypertension control. Methods: This prospective and double blind investigation included 211 outpatient adult hypertensive participants having or not other Comorbid diseases , aged 30-70 years, of both sexes and who visited the general medicine clinic at Prince Hashim military hospital, Zarqa, JORDAN, during the period Apr 2016-Feb 2018. The data's for use of antihypertensive agents were collected from patient's medical files. The antihypertensive agents included were: Beta Blockers (BBs), Diuretics, Angiotensin Converting Enzyme Inhibitors (ACEI), Calcium Channel Blockers (CCBs), and angiotensin receptor blockers (ARBs) .Antihypertensive agents use prevalence and percentage as single or multiple therapy was evaluated. Z test was used to record the P value of age difference between two sexes. P value was considered statistically significant if it was less than 0.05. Results: The most commonly single used antihypertensive agents were Angiotensin Converting Enzyme Inhibitors (ACEI) (28.3%). In decreasing order come: Calcium Channel Blockers (CCBs) (23.3%), BBs (Beta Blockers)(18.3%), angiotensin receptor blockers (ARBs) (18.3%) and diuretics(11.7%). Multiple therapies was administered more in 71.6% (151) of patients than single therapy which was administered in 28.4% (60) of patients. Hypertension was more in men with increasing age than women. Conclusion: Angiotensin Converting Enzyme Inhibitors were the commonest antihypertensive used agents whether in single or multiple therapies.
Clinical Cardiology, 1991
Therapeutic options for initial antihypertensive treatment include the four most popular classes of drugs: diuretics, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, and calcium antagonists. The practitioner must decide which agent is appropriate for each patient, the main goal of treatment being to prevent stroke and coronary events-sudden death and myocardial infarction. A 40% reduction in stroke can probably be achieved with any antihypertensive treatment, but data show that it is much more difficult to reduce the risk of coronary events. Available evidence from studies in men indicates that certain beta blockers are superior to thiazide diuretics for the prevention of coronary events. Results from the Metoprolol Atherosclerosis Prevention in Hypertensives (MAPHY) Trial showed that the risk for coronary events was 24% lower in patients receiving metoprolol than in patients receiving diuretics (p<O.O01), with beneficial effects in smokers as well as nonsmokers. Present data might suggest that different beta blockers may have different efficacy in preventing coronary events. Clinical triuls have not yet produced long-term prognostic data on the effects of ACE inhibitors or calcium antagonists on the incidence of coronary events in hypertensive patients. Pooled data on calcium antagonist therapy in postmyocardial infarction patients indicate a trend toward higher mortality with calcium antagonists than with placebo. Because of the large number of hypertensive patients at increiised risk for coronary events, the reduction in
International Journal of Pharmacy and Pharmaceutical Sciences, 2016
The aim of the study is to assess the various prescribing patterns in hypertension with different compelling indications. Methods: It is a prospective observational study and carried out for a period of 1 y from Feb-2014 to Feb-2015. All the required data was collected from patients through personal interview and prescriptions. The data collected from the participants was entered into Microsoft excel spreadsheet and descriptive statistics were used. The mean and standard deviation (SD) were calculated. Results: A total of 394 hypertensive patients with different comorbidities were included in which 251(63.70%) males and 143(36.29%) females were present with a mean (SD) age of 59.21±1.54. The most commonly reported first three co-morbidities along with hypertension were diabetes mellitus 191 (48.47%), stroke accounts for 57 (14.46%) and coronary artery disease in 32 (8.12%). Monotherapy was given in almost 200 (50.76%) patients and dual drug therapy was indicated in 166 (42.13%) patients, triple therapy was used only in 24 (6.09%) patients in the total sample size. Quadruple therapy is the least preferred combination therapy accounts only in 4 (1.01%) patients. Conclusion: We conclude that calcium channel blockers and angiotensin II receptor blockers were the most commonly prescribed class of drugs either alone or in combination with other class of drugs for effective control of blood pressure patients with different compelling indications. Monotherapy was preferred than combination therapy.
Antihypertensive drug prescription trends at the primary health care centres in Bahrain
Pharmacoepidemiology and Drug Safety, 2001
Purpose To determine the antihypertensive drug prescribing pattern by primary care physicians in patients with uncomplicated essential hypertension; to identify whether such pattern of prescription is appropriate and in accordance with international guidelines for pharmacotherapy of hypertension; and to estimate the impact of such prescriptions on cost of treatment.