Article

Prognostic Influence of Office and Ambulatory Blood Pressures in Resistant Hypertension

Rua Croton, 72, Jacarepagua, Rio de Janeiro - RJ, Brasil, CEP: 22750-240.
Archives of internal medicine (Impact Factor: 17.33). 12/2008; 168(21):2340-6. DOI: 10.1001/archinte.168.21.2340
Source: PubMed

ABSTRACT

The prognostic value of office and ambulatory blood pressures (BPs) in patients with resistant hypertension is uncertain.
This prospective study investigates the importance of office and ambulatory BPs as predictors of cardiovascular morbidity and mortality. At baseline, 556 resistant hypertensive patients underwent clinical-laboratory and 24-hour ambulatory BP monitoring examinations. Primary end points were a composite of fatal and nonfatal cardiovascular events and all-cause and cardiovascular mortalities. Multiple Cox regression was used to assess associations between BP and subsequent end points.
After median follow-up of 4.8 years, 109 patients (19.6%) reached the primary end point, and 70 all-cause deaths (12.6%) occurred (46 had cardiovascular causes). After adjustment for age, sex, body mass index, diabetes mellitus, smoking, physical inactivity, dyslipidemia, previous cardiovascular diseases, serum creatinine level, and number of antihypertensive drugs in use, no office BP showed any prognostic value. After further adjustment for office BP, higher mean ambulatory BPs were independent predictors of the composite end point. The hazard ratios associated with a 1-SD increment in daytime and nighttime systolic BP were 1.26 (95% confidence interval, 1.04-1.53) and 1.38 (1.13-1.68), respectively; the corresponding values for diastolic BP were 1.31 (1.05-1.63) and 1.36 (1.10-1.69). Ambulatory systolic and diastolic BP were equivalent predictors, and both were better than pulse pressure; nighttime BP was superior to daytime BP. For all-cause mortality, only the ambulatory BP monitoring diagnosis of true resistant hypertension was an independent predictor.
Higher ambulatory BP predicts cardiovascular morbidity and mortality in resistant hypertensive patients, whereas office BP has no prognostic value.

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Available from: Elizabeth S Muxfeldt, Aug 20, 2014
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    • "Clinically significant differences in blood pressure between morning and evening dosing of antihypertensive single or combination therapy of angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium-channel blockers (CCBs), αblockers , β-blockers and diuretics was demonstrated in several studies. However, majority of hypertensive patients are unaware and not adherent to biological rhythm when taking their antihypertensive medications (Hermida et al., 2013 and Salles et al., 2008). The role of pharmacists has evolved from being " product oriented " focusing on dispensing "
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    ABSTRACT: ARTICLE INFO ABSTRACT Objective: This study aims to evaluate the practice and knowledge of Saudi pharmacists regarding chronopharmacology of antihypertensive drugs. Method: A Descriptive cross – sectional questionnaire based survey of randomly selected community pharmacists from Riyadh city in Kingdom of Saudi Arabia in March and April 2014. Sample consisted of randomly selected 100 community pharmacists. Results: 100% of participants agreed that physical activity, stress, environmental, and endocrine alterations affect daily blood pressure. However, 35% did not know that blood pressure has two peaks; around 9:00 am and 7:00 pm, and one drop around 3:00 am. In addition, 24% of pharmacists did not know whether or not evening dose of nifedipine and GTN was more successful in decreasing the blood pressure as compared to the early hours in the morning. Conclusion: Our study shows that knowledge and practice of community pharmacists need further improvement about interaction between time of administration of anti-hypertensive drugs and its efficacy.
    Full-text · Article · Mar 2015
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    • "Clinically significant differences in blood pressure between morning and evening dosing of antihypertensive single or combination therapy of angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium-channel blockers (CCBs), αblockers , β-blockers and diuretics was demonstrated in several studies. However, majority of hypertensive patients are unaware and not adherent to biological rhythm when taking their antihypertensive medications (Hermida et al., 2013 and Salles et al., 2008). The role of pharmacists has evolved from being " product oriented " focusing on dispensing "
    [Show abstract] [Hide abstract]
    ABSTRACT: ARTICLE INFO ABSTRACT Objective: This study aims to evaluate the practice and knowledge of Saudi pharmacists regarding chronopharmacology of antihypertensive drugs. Method: A Descriptive cross – sectional questionnaire based survey of randomly selected community pharmacists from Riyadh city in Kingdom of Saudi Arabia in March and April 2014. Sample consisted of randomly selected 100 community pharmacists. Results: 100% of participants agreed that physical activity, stress, environmental, and endocrine alterations affect daily blood pressure. However, 35% did not know that blood pressure has two peaks; around 9:00 am and 7:00 pm, and one drop around 3:00 am. In addition, 24% of pharmacists did not know whether or not evening dose of nifedipine and GTN was more successful in decreasing the blood pressure as compared to the early hours in the morning. Conclusion: Our study shows that knowledge and practice of community pharmacists need further improvement about interaction between time of administration of anti-hypertensive drugs and its efficacy.
    Full-text · Article · Mar 2015
  • Source
    • "Clinically significant differences in blood pressure between morning and evening dosing of antihypertensive single or combination therapy of angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium-channel blockers (CCBs), αblockers , β-blockers and diuretics was demonstrated in several studies. However, majority of hypertensive patients are unaware and not adherent to biological rhythm when taking their antihypertensive medications (Hermida et al., 2013 and Salles et al., 2008). The role of pharmacists has evolved from being " product oriented " focusing on dispensing "

    Full-text · Article · Mar 2015
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