Predictors of blood pressure response to intensified and fixed combination treatment of hypertension: the ACCOMPLISH study.
ABSTRACT Avoiding Cardiovascular events through COMbination therapy in Patients LIving with Systolic Hypertension (ACCOMPLISH) is an outcome study investigating aggressive antihypertensive combination treatment. It has achieved a larger fraction of overall patients with blood pressure (BP) <140/90 mmHg (73.3%) and diabetic patients <130/80 mmHg (43.3%) at 12 months of follow-up than any other large outcomes trial. We have analyzed baseline predictors of BPs and BP control at 12 months.
Blinded baseline and 12-month BP was available in 10,173 patients of whom 6132 had diabetes. Univariate and multivariate logistic regression models were used for BP control at 12 months; simple and multiple regression models were used for absolute BP value at 12 months. A stepwise procedure was used to select significant predictors in multivariate analyses.
Mean (SD) BP fell from 145.5/80.2 mmHg (18.2/10.7 mmHg) at randomization to 132.7/74.7 mmHg (16/9.6 mmHg) at 12 months. The main baseline predictors of achieving BP control were region (USA), Caucasian race and taking lipid-lowering drugs. The predictors of uncontrolled BP were higher baseline systolic BP values, more previous antihypertensive medications, proteinuria and previous thiazide use.
Patients in the USA, Caucasians and patients taking lipid-lowering therapy were most likely to reach BP targets with combination therapy. Strong predictors of uncontrolled hypertension were more severe hypertension, an established need for more antihypertensive drugs and target organ damage.
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ABSTRACT: BACKGROUND: The prescription of fixed-dose combinations (FDC) of antihypertensive drugs has increased rapidly since the relaxation of the prescription-term restriction.In this study, we used the opportunity of this policy change in Japan as an instrument to assess the causal impact of switching to FDC on hypertensive treatment costs. METHODS: Claims data from 64 community pharmacies located in Tokyo were used to identify hypertensive patients under continuous treatment with angiotensin-receptor blockers (ARBs). Patients switching to FDC between December 2010 and April 2011 were compared to patients who did not receive FDC (control group). Changes in annual antihypertensive drug costs were compared using a difference-in-differences approach to adjust for patient characteristics and use of concomitant medication. Subpopulation analyses were also performed, taking into account pre-index treatment patterns and prescribers' characteristics. RESULTS: There were 542 patients who switched to FDC and 9664 patients in the control group. No significant differences were observed between the 2 groups, except for antihypertensive drug use patterns before the policy change and prescribers' characteristics. The switch to FDC was associated with an annual saving of 10,420 yen (US$112.0) in antihypertensive drug costs. Approximately 20% of the FDC patients, however, switched from ARB alone, and their drug costs increased by 2376 yen (US$25.5). CONCLUSIONS: For hypertensive patients who required ARB-based combination therapy, switching to FDC drugs had a significant cost-saving effect. However, the policy change of relaxing the prescription-term restriction could encourage aggressive treatment, i.e., switching to a combination therapy from monotherapy, regardless of medical conditions. Further research is required to evaluate the possible negative aspects of FDC drugs.BMC Health Services Research 04/2013; 13(1):124. · 1.77 Impact Factor
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ABSTRACT: A simple, rapid, and selective HPLC-UV method was developed for the determination of antihypertensive drug substances: amlodipine besilat (AML), olmesartan medoxomil (OLM), valsartan (VAL), and hydrochlorothiazide (HCT) in pharmaceuticals and plasma. These substances are mostly used as combinations. The combinations are found in various forms, especially in current pharmaceuticals as threesome components: OLM, AML, and HCT (combination I) and AML, VAL, and HCT (combination II). The separation was achieved by using an RP-CN column, and acetonitrile-methanol-10 mmol orthophosphoric acid pH 2.5 (7 : 13 : 80, v/v/v) was used as a mobile phase; the detector wavelength was set at 235 nm. The linear ranges were found as 0.1-18.5 μ g/mL, 0.4-25.6 μ g/mL, 0.3-15.5 μ g/mL, and 0.3-22 μ g/mL for AML, OLM, VAL, and HCT, respectively. In order to check the selectivity of the method for pharmaceutical preparations, forced degradation studies were carried out. According to the validation studies, the developed method was found to be reproducible and accurate as shown by RSD ≤6.1%, 5.7%, 6.9%, and 4.6% and relative mean error (RME) ≤10.6%, 5.8%, 6.5%, and 6.8% for AML, OLM, VAL, and HCT, respectively. Consequently, the method was applied to the analysis of tablets and plasma of the patients using drugs including those substances.Journal of analytical methods in chemistry. 01/2013; 2013:179627.
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ABSTRACT: Hypertension is common in people aged 65 and older. African Americans and women have a higher prevalence of hypertension than white individuals, and in those aged 70 and older, the hypertension was more poorly controlled than in those aged 60-69. The number of trials available in the elderly population compared with the general population are limited; hence, the database for strong recommendations as to goal blood pressure (BP) are limited. The American College of Cardiology with the American Heart Association has recently published a consensus report of management of hypertension in the elderly population. This review presents an overview of this consensus report and reviews specific studies that provide some novel findings regarding goal BP and progression of nephropathy. In general, the evidence strongly supports a BP goal of less than 150/80 mmHg. The evidence review for the consensus report supports a goal of <150/80 mmHg for the elderly with scant data in those over age 80. However, it was decided to set the goal to less than 140/90 mmHg unless the patient cannot tolerate it and then try for 140-145 mmHg. The data are scant at best for those over age 80 mmHg but some evidence exists for <150/80 mmHg. Diuretics and calcium antagonists are the most efficacious single agents for treatment; however, most patients will require two or more drugs to achieve such goals. Decision Editor: Luigi Ferrucci, MD, PhD.The Journals of Gerontology Series A Biological Sciences and Medical Sciences 08/2012; · 4.31 Impact Factor