Selecting antihypertensive medication in patients with essential hypertension in Malaysia (original) (raw)
Related papers
2016
Hypertension is one of the silent killer diseases influenced by many factors. The prevalence of hypertension in Indonesia is 7.6 % in 2013 and then increased to 9.5%. This study aimed to determine the drug effectiveness and cost-efficiency in the treatment of hypertension patients who use antihypertensive drugs combinations (ACEI-CCB and ACEI-Diuretic) at outpatient unit Mintohardjo Navy Hospital Jakarta during period from June to November 2015. This study was a cohort design to measure the cost effectiveness of antihypertensive drugs combination ACEI-CCB and ACEI-Diuretic. The data were collected prospectively from medical record of outpatient hypertension visiting Mintohardjo Navy Hospital, Jakarta. The samples size was 200 patients with hypertension who meet the inclusion and exclusion criteria and divided into 2 groups. Group 1 was 100 hypertension patients using antihypertensive drugs combination ACEI-CCB and group 2 with the combination of ACEI-Diuretic. Both groups of patients who get antihypertensive drugs combination followed and observed for 3 months for each patient. The drug's effectiveness is measured by counting the number of patients having blood pressure in under control (<140/90 mmHg) and 130/80 mmHg for patients with diabetes mellitus. Cost efficiency is measured on the basis of the unit cost of each group and the value of the ratio of cost effectiveness. The results showed that the greatest effective therapetic of drug found in the combination of ACEI-CCB marked by the patient's controlled blood pressure was 98%, whereas the controlled blood pressure in the group of ACEI-Diuretic patients was only 91%. Efficiency found in the Group ACEI-Diuretic marked by the lowest unit cost of IDR 1.073.848, whereas in the Group of ACEI-CCB of IDR 1.096.790. The antihypertensive drugs combination ACEI-CCB is more effective than ACEI-Diuretic combination. The antihypertensive drug combination ACEI-Diuretik is more efficient than ACEI-CCB combination
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.
Trials, 2011
Background: Blood pressure (BP) within pre-hypertensive levels confers higher cardiovascular risk and is an intermediate stage for full hypertension, which develops in an annual rate of 7 out of 100 individuals with 40 to 50 years of age. Non-drug interventions to prevent hypertension have had low effectiveness. In individuals with previous cardiovascular disease or diabetes, the use of BP-lowering agents reduces the incidence of major cardiovascular events. In the absence of higher baseline risk, the use of BP agents reduces the incidence of hypertension. The PREVER-prevention trial aims to investigate the efficacy, safety and feasibility of a populationbased intervention to prevent the incidence of hypertension and the development of target-organ damage. Methods: This is a randomized, double-blind, placebo-controlled clinical trial, with participants aged 30 to 70 years, with pre-hypertension. The trial arms will be chlorthalidone 12.5 mg plus amiloride 2.5 mg or identical placebo. The primary outcomes will be the incidence of hypertension, adverse events and development or worsening of microalbuminuria and of left ventricular hypertrophy in the EKG. The secondary outcomes will be fatal or non-fatal cardiovascular events: myocardial infarction, stroke, heart failure, evidence of new sub-clinical atherosclerosis, and sudden death. The study will last 18 months. The sample size was calculated on the basis of an incidence of hypertension of 14% in the control group, a size effect of 40%, power of 85% and P alpha of 5%, resulting in 625 participants per group. The project was approved by the Ethics committee of each participating institution.
Suboptimal control blood pressure (BP) leads to multiple complications. This study aims to examine BP control and the change in prescribing pattern of antihypertensive agents over a 10-year period. Data was obtained from the 10-year retrospective cohort of randomly selected adult patients registered with the Department of Primary Care Medicine Clinic at the University of Malaya Medical Centre. Demographic data, BP and anti-hypertensive drug use in 1998, 2002 and 2007 were captured from patient records. Target BP control was defined as BP <140/90mmHg for those with hypertension alone and <130/80mmHg for those hypertensives with concomitant diabetes mellitus or chronic kidney disease. A total of 886 hypertensives patients were recruited. The mean age was 57.2 years (SD±9.6); 63.1% were female. The mean BP at baseline and at the end of 10-year were 146 / 87 (18/10) mmHg and 136/80 (16/9) mmHg respectively. In 1998, 74.3%, 22.5% and 1.6% were on monotherapy, 2 agents and ≥3 agents respectively. In 2007 after 10 years, 24.9%, 46.5% and 26.9% were on monotherapy, 2 agents and ≥3 agents respectively. At the end of 10 years there was improvement in overall blood pressure control, increasing from 15.6% in 1998 to 43.7% in 2007. However, the control rate of BP is still far from optimal in spite of an increase in the number of agents per patients used over a10 year follow-up. Based on our study the majority of patients with hypertension will need 2 or more agents to achieve target BP.
Spectrum of antihypertensive therapy in South Asians at a tertiary care hospital in Pakistan
BMC Research Notes, 2011
Background: Despite available guidelines on hypertension (HTN), use of antihypertensives is variable. This study was designed to ascertain frequency of patients on monotherapy and > 1 antihypertensive therapy and also to ascertain proportion of patients on diuretic therapy. Methods: It was a crossectional study conducted on 1191 adults(age > 18 yrs)hypertensive patients selected by computerized International Classification of Diseases -9-coordination and maintenance (ICD-9-CM) presenting to a tertiary care hospital in Pakistan. Data on demographics, comorbids, type of antihypertensive drug, number of antihypertensive drug and mean duration of antihypertensive drug was recorded over 1.5 year period (2008-09). Blood pressure was recorded on admission. Primary outcome was use of combination therapy and secondary outcome was use of diuretic therapy. Results: A total of 1191 participants were included. Mean age(SD) was 62.55(12.47) years, 45.3%(540) were males. Diabetes was the most common comorbid; 46.3%(551). Approximately 85% of patients had controlled hypertension. On categorization of anti hypertensive use into 3 categories;41.2%(491) were on monotherapy,32.2% (384) were on 2 drug therapy,26.5%(316) were on ≥3 drug therapy. Among those who were on monotherapy for HTN;34%(167) were on calcium channel blockers,30.10%(148) were on beta blockers, 22.80%(112) were on Angiotensin converting enzyme (ACE) inhibitors,12%(59) were on diuretics and 2.20%(11) were on Angiotensin receptor blockers(ARB). Use of combination antihypertensive therapy was significantly high in patients with ischemic heart disease(IHD)(p < 0.001). Use of diuretics was in 31% (369) patients. Use of diuretics was significantly less in patients with comorbids of diabetes (p 0.02), Chronic kidney disease(CKD)(p 0.003), IHD (p 0.001) respectively Conclusion: Most patients presenting to our tertiary care center were on combination therapy. Calcium channel blocker is the most common anti hypertensive drug used as monotherapy and betablockers are used as the most common antihypertensive in combination. Only a third of patients were on diuretic as an antihypertensive therapy.
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2017
The aim of this study was to determine how often the recommendations of the Turkish Hypertension Consensus Report are followed, and to draw attention to the report. Methods: The demographic information of 1000 patients diagnosed with hypertension and the details of the antihypertensive medications prescribed at the outpatient service of a tertiary care hospital were recorded, and the data were compared with the recommendations of the report. Results: The mean age of the patients was 62±11 years. In all, 623 (62.3%) of the 1000 patients were women, and 377 (37.7%) were men. A combination of an angiotensin II receptor blocker (ARB) and a diuretic was the most frequently observed prescription. A diuretic was the most used antihypertensive drug (58.7%), followed by an ARB (48.8%). However, as a monotherapy, a calcium channel blocker (CCB) was the most commonly used antihypertensive drug (19.2%). The most frequently used antihypertensive drug group in older patients was diuretics (63.6%), as proposed in the report. Beta blockers (49.1%) were used more often than expected. For the diabetic group also, a diuretic (60.7%) was the most frequently used antihypertensive drug, followed by an ARB (51.1%) and a CCB (45.2%). Angiotensin-converting enzyme (ACE) inhibitors (34.6%) were the fifth most preferred antihypertensive drug class. However, when ACE inhibitors and ARBs were considered as a single group, known as reninangiotensin system (RAS) blockers, these RAS blockers were the most prescribed antihypertensive drug class, followed by diuretics. In the group of patients with coronary artery disease, treatment was found to be generally consistent with the report, but the use of diuretics was greater than expected. Lastly, 124 of 160 patients who had chronic kidney disease were given RAS blocker therapy, which was in line with the consensus report recommendations. Conclusion: Antihypertensive therapies were individualized, as suggested by the consensus report. However, there are proposals still to be considered in special patient groups.
A Meta-Analytical Approach to the Efficacy of Antihypertensive Drugs in Reducing Blood Pressure
American Journal of Cardiovascular Drugs, 2005
the treatment of hypertension. The objective of this meta-analytical approach was to assess the efficacy of antihypertensive drugs most commonly used in France in reducing clinical SBP and DBP. Methods: The antihypertensive drugs selected were hydrochlorothiazide, indapamide sustained release (SR), furosemide and spironolactone for diuretics; amlodipine and lercanidipine for calcium channel antagonists; atenolol for ↑-adrenoceptor antagonists (↑-blockers); enalapril and ramipril for ACE inhibitors; and candesartan cilexetil, irbesartan, losartan, and valsartan for angiotensin II receptor antagonists. The trials selected were published between 1973 and 2004, evaluated monotherapy with trial drugs as fixed-dosage or with dosage increase, and assessed blood pressure reduction between 2 and 3 months. The analysis method used was based on the calculation of the sum weighted for the trial size. Results: A total of 72 trials (comprising 9094 patients) were selected and analyzed. No trial evaluating furosemide or spironolactone satisfied the inclusion criteria for this analysis. For SBP, the reduction was more marked with diuretics, calcium channel antagonists, and ACE inhibitors. Of all the drugs studied, indapamide SR gave the greatest SBP reduction (-22.2mm Hg). Evaluated therapeutic classes had a similar magnitude of effect on DBP, i.e. reduction between -11.4mm Hg with ↑-adrenoceptor antagonists and -10.3mm Hg with angiotensin II type 1 receptor antagonists. Conclusion: Indapamide SR 1.5mg appeared to be the most effective drug for a significant reduction in SBP within 2-3 months, which is an essential element in optimizing cardiovascular prevention among hypertensive patients. The clinical application of these results should take into consideration all the limitations discussed in this analysis.
The Lancet, 2019
Background: Uncertainty lingers about optimal monotherapy initiation for hypertension. Recent guidelines recommend starting any primary agent among five first-line drug classes, thiazide or thiazide-like diuretics (THZ), angiotensin converting-enzyme inhibitors (ACEi), angiotensin receptor blockers, dihydropyridine calcium channel blockers, and non-dihydropyridine calcium channel blockers (ndCCB), in the absence of comorbid indications. Randomized trials fail to further refine this choice. Methods: We develop a comprehensive framework for real-world evidence that enables comparative effectiveness and safety evaluation across many drugs and outcomes from observational data encompassing millions of patients while minimizing inherent bias. Using this framework, we conduct a systematic, large-scale study under a new-user cohort design to estimate the relative risks of 3 primary and 6 secondary effectiveness and 46 safety outcomes comparing all first-line classes across a global network of 6 administrative claims and 3 electronic health record databases. The framework addresses residual confounding, publication bias and p-hacking using large-scale propensity adjustment, a large set of control outcomes, and full disclosure of hypotheses tested. Findings: Using 4.9 million patients, we generate 22,000 calibrated, propensity-score adjusted hazard ratios (HRs) comparing all classes and outcomes across databases. Most estimates reveal no effectiveness differences between classes. THZ, however, demonstrate better primary effectiveness than ACEi: acute myocardial infarction (HR 0.84; 95% CI 0.75-0.95), hospitalization for heart failure (0.83; 0.74-0.95) and stroke (0.83; 0.74-0.95) risk while on initial treatment. Safety profiles also favor THZ over ACEi. The ndCCB drugs are significantly inferior to the other four classes. Interpretation: This comprehensive framework introduces a new way of conducting observational healthcare science at scale. The approach supports equivalence between drug classes for initiating monotherapy for hypertension-in keeping with current guidelines-with the exception of THZ superiority to ACEi and the inferiority of ndCCB.