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Introduction: Physical exercise and antihypertensive drugs contribute to reduce or prevent hypertensive heart disease (HHD). The effect on blood pressure (BP) of both combined therapy is well documented, but not for the left ventricular (LV) function. Aim: A systematic review and meta-analysis was conducted for LV biomarkers analysis regarding to HHD on subjects treated with antihypertensive drugs combined with physical exercise practice. Methods: The search was conducted on the Pubmed, Bireme, Lilacs, Central (Cochrane) and Science direct databases, comprising undetermined period of time, including randomized studies comparing trained and sedentary subjects, both treated with antihypertensive drugs. We analyzed the influence of combined therapy on echocardiogram parameters and BP. A significance level of 5% and 95% CI was considered for all outcomes. Results: Five studies (N = 1738) were included in meta-analysis. Combined therapy decreased significantly LV mass (CI − 21.63 to − 1.81, N = 783) and heart rate (HR; CI − 4.23 to − 1.59, N = 1738), compared to antihypertensive drugs alone. There was a trend to decrease LV mass index (LVMI; CI − 5.57 to 0.71, N = 1674), systolic BP (CI − 2.47 to 1.23, N = 1674) and diastolic BP (CI − 2.16 to 0.28, N = 1674), a trend to increase of ejection fraction (EF; 95% CI − 0.50 to 2.12, N = 783) and LV end-diastolic diameter (CI − 0.85 to 0.92, N = 847) was similar. Conclusion: The antihypertensive therapy combined with physical exercise practice can reduce LV mass and HR. Therefore, combined therapy prescription should be considered for prevention and treatment of LV hypertrophy of hypertensive subjects. [ABSTRACT FROM AUTHOR]

Introduction: Knowledge about hypertension might influence blood pressure (BP) control and adherence to treatment. Aim: This study was conducted in collaboration with 11 pharmacies to assess the level of knowledge about hypertension and BP targets among the hypertensive population in the French region of Alsace. Methods: Study participants (N = 380) were hypertensive adult patients visiting a pharmacy spontaneously from June to October, 2013, to get their regular prescribed medications including at least one antihypertensive agent. After filling a questionnaire, they were asked to record their BP themselves. Results: The participants were 66 years of age, mostly women (51%), non smokers (80%), with an education level lower than A-level (70%). Of them, 35% were obese and 74% reported being hypertensive for more than 12 years. Almost half of them used a home BP monitor. When queried about BP targets, 78% of participants gave values under 140/90 mm Hg. Heart disease and stroke were reported to be associated with hypertension by 78 and 66% of participants, respectively. Participants were taking two pharmacological classes mostly administered as fixed-combination drugs and 39.5% were compliant. Optimal BP targets (135/85) were achieved by 43%. A better BP control was observed significantly (p = 0.02) more often when BP targets were known. Uncontrolled participants were more likely (p = 0.006) to be aware of being hypertensive and less satisfied with BP control (p = 0.003). Conclusions: This study highlights the impact of patient knowledge and BP self-monitoring as well as the role of pharmacists to improve hypertension control. [ABSTRACT FROM AUTHOR]

Adherence to antihypertensive therapy is critical to achieving adequate blood pressure control. About half of hypertensive patients do not take their drugs as directed and the physicians often underestimate this issue. Non-adherence has important public health economic implications (numbers of visits, diagnostic procedures, prescribed drugs) and, moreover, it results in increased morbidity and mortality rates. Poor adherence can have several patients and therapy related causes. Currently, multiple different direct and indirect methods to measure therapeutic adherence are available, but, in clinical practice, there is no cost-effective and simple one. Therapeutic drug monitoring (TDM), characterized by drug (or metabolites) concentration measurement in body fluids (blood or urine), is a cost-effective direct method to assess therapeutic adherence. Despite some limitations, TDM may decrease health costs, by reducing the number of visits and by identifying those patients who would undergo unnecessary invasive procedures. Moreover, TDM can be a new alternative method to identify patients with true resistant hypertension, improving the achievement of blood pressure control In this minor revision, we would assess poor therapeutic adherence in hypertensive population, analyzing the different direct and direct available methods, with emphasis on TDM. [ABSTRACT FROM AUTHOR]

Introduction: Although improved during the past few years, high blood pressure control still remains an unmet goal of antihypertensive drug treatment. Among different antihypertensive agents, calcium channel blockers (CCBs), either as monotherapy or in combination with other drugs are recommended by several guidelines for initiation and maintenance of antihypertensive treatment. Aim: The HYT-HYperTension survey, carried out in Turkey was aimed to assess (a) blood pressure control in hypertensive patients under treatment with dihydropyridine CCBs, either as monotherapy or in combination with other drugs and (b) the prevalence of blood pressure control in subgroups of patients with cardiovascular risk factors (previous cardiovascular disease, diabetes, renal disease, isolated systolic hypertension, visceral obesity, overweight, current smoking habit). Methods: More than 7000 hypertensive patients (60.0 % men, mean age 61.2 ± 11.5 years), routinely visited by either a specialist or a non-specialist physician in the Primary Care Units of 26 cities across Turkey, were enrolled in the survey. Only patients treated with dihydropyridine-type CCBs, as mono- or combination therapy were included in the study, whereas individuals treated with non-dihydropyridine-type CCBs or with other drug classes (as monotherapy or combination therapy), were excluded. Demographic data (age, gender, height, weight, waist circumference, current smoker habit), clinical data and drug treatments were collected at each visit. Blood pressure was measured with a semiautomatic device (Omron-M6) with the patient in sitting position and after at least 5 min of rest. Measurements were repeated three times, at intervals of 5 min each other. Results: In the overall survey population blood pressure control (blood pressure <140/90 mmHg) was achieved in 31.7 % of patients and the average systolic and diastolic blood pressure was 145.3/88.2 mmHg. Prevalence of patients treated with dihydropyridine-type CCBs, either as monotherapy or combined with other drugs, was superimposable (51.6 vs 48.4 %, P = NS). Dihydropyridine-type CCBs were more frequently combined with drugs acting on the renin-angiotensin-aldosterone system (86.4 %), particularly with ACE-inhibitors (34.1 %) and angiotensin II receptor antagonists (52.3 %), while in 13.6 % of patients CCBs were combined with diuretics and/or beta-blockers. Diabetes mellitus was detected in 22.7 % of patients, obesity in 41.5 % and history of cardiovascular disease in 23.0 % (coronary artery disease in 19.2 % and stroke in 3.8 %). Blood pressure control was more difficult to be achieved in complicated hypertension, particularly when cigarette smoking, obesity, overweight, visceral obesity and renal disease were associated with hypertension. Conclusions: Taken together these findings provide evidence that dihydropyridine-type CCBs, particularly when combined with ACE-inhibitors or angiotensin II receptors blockers, allow to achieve a blood pressure control better than the one reported in the same geographic area by other treatment strategies based on different combinations of diuretics, beta-blockers, ACE-inhibitors, angiotensin II receptors blockers and calcium channel blockers. [ABSTRACT FROM AUTHOR]

Introduction: The recommendation to start antihypertensive therapy with diuretics (D) might produce delay in blood pressure (BP) control and, possibly, increase cost/benefit ratio. Aim: We evaluate the effects of D in relation to the administration of other anti-hypertensive medications, in clinical practice. Methods: General practitioners recruited 2,409 hypertensive patients with indication to antihypertensive therapy, who were randomized to start treatment with chlorthalidone (12.5-25 mg daily, group D) or any other single medications (excluding thiazides, group A). The patients have been followed for at least 2 years. Result: Among the 2,409 patients recruited (42.5 % women), 1,205 were randomized in group D and 1,204 in group A, of which 1,051 (or 87 %) and 1026 (or 85 %) respectively, completed the study. The number of patients in optimal BP control was similar in the two groups (65.0 vs 64.0 %; p = NS). During follow-up, the group D had prescribed a slightly greater number of medications compared to the group A who added D as second line (2.3 vs 2.1; p < 0.0001). In particular group D took more β-blockers (27.1 vs 14.9 %; p < 0.0001) with a similar number of patients in optimal BP control (64.35 vs 63.9 %; p = NS). Conclusion: The beginning of antihypertensive therapy with diuretics is more often subject to the addition of one or more medications to obtain an effective blood pressure control, since the diuretic administered at the beginning of the antihypertensive regimen is only rarely associated with optimal blood pressure control. [ABSTRACT FROM AUTHOR]

The aim of this review was to summarize recent findings on patients' adherence and persistence to antihypertensive (AHT) therapy. A literature search was performed using MEDLINE for original studies published in the English language between April 2003 and July 2008. According to selection criteria, the review included 47 papers classified into the following groups: (i) studies assessing overall behaviour towards treatment; (ii) studies differentiating among AHT classes; and (iii) studies comparing specific AHTs. It was not possible to perform a meta-analysis due to the wide variety of study designs, objectives and definitions. However, some strong messages emerged: non-adherent patients have higher blood pressure (BP) values, which lead to a higher risk of cardiovascular events; angiotensin II type 1 receptor antagonists (angiotensin receptor blockers) are the AHTs with the best patient adherence and persistence to treatment; better treatment adherence is observed in patients using fixed versus extemporaneous AHT combinations. Improving BP control is pivotal to reduce cardiovascular events, allowing for a better use of healthcare resources, and good adherence and persistence to treatment are essential for reaching this goal. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is a powerful risk factor for cardiovascular disease (CVD), and most persons with diabetes ultimately succumb to coronary artery disease or stroke. The coincidence of hypertension and diabetes is common and, over the long term, sharply increases cardiovascular risk. The incidence of diabetes (new-onset diabetes [NOD]) among hypertensive persons is high, and appears to be increased during antihypertensive therapy. NOD is a distressing clinical event, provoking psychological distress, more clinical testing, and, sometimes, the need for hypoglycaemic therapy. Diuretics and β-blockers are more likely to provoke NOD than other drugs that block the renin angiotensin system, or calcium channel blocking agents, It is important to note that the alternative agents have not been shown to prevent the emergence of hyperglycaemia, but seem to be metabolically neutral. It is also true that because diuretic-induced NOD may be due to hypokalaemia, it can sometimes be reversed without sacrificing diuretic therapy. The evidence suggests that most NOD appearing during antihypertensive therapy is not drug induced, but rather part of the natural history of disease. Since diabetes is such a powerful CVD risk factor, it can hardly be surprising that, over the long term, NOD is associated with increased CVD. However, there is no evidence in short-term clinical trials that diuretic-induced NOD increases CVD or detracts from the cardioprotective effects of these agents. Indeed, long-term follow-up of participants in a large placebo-controlled trial of diuretic therapy in elderly hypertensive subjects suggests that this antihypertensive therapy actually eliminates the expected increase in CVD. In summary, although NOD can hardly be dismissed as a trivial event, concern about its possible occurrence is not a reason to influence initial antihypertensive drug selection, nor does its appearance provide a reason to compromise antihypertensive therapy. Indeed, the available evidence suggests that blood pressure control trumps hypoglycaemic therapy as the very best tool for CVD prevention in new or established diabetic subjects. [ABSTRACT FROM AUTHOR]

In a recent issue of High Blood Pressure and Cardiovascular Prevention, a very interesting debate on the clinical and prognostic significance of new-onset diabetes mellitus in hypertension was held by Prof. M.H. Alderman and Prof. P. Verdecchia. Beside the major objectives of the debate, both authors included in their discussion references to the potential influence of antihypertensive treatments on susceptibility to diabetes development. Indeed, in the last few years, especially after the introduction of this treatment as a secondary or additive endpoint in interventional clinical trials on hypertension, new-onset diabetes has raised the interest of physicians, and actually represents a 'hot topic' in the global cardiovascular risk profile and consequent therapeutic management in hypertension. The following editorial provides some element of discussion. Obviously, it cannot be conclusive, although it may stimulate active and direct investigation on this aspect, which can have a major influence on healthcare systems expenditure, given the uprising prevalence of hypertension and the mounting prognostic importance of diabetes in the adult and elderly hypertensive population. [ABSTRACT FROM AUTHOR]

Several intervention trials found that some antihypertensive drugs, mostly ACE inhibitors, calcium-channel blockers and angiotensin II receptor blockers, are associated to a lesser risk of developing diabetes mellitus in comparison with other drug classes, including diuretics and β-blockers. This finding is clinically relevant because it has been demonstrated that patients who develop new-onset diabetes during therapy rapidly become a high-risk population, not dissimilar from patients with prior diagnosis of diabetes. In a recent analysis of the PIUMA (Progetto Ipertensione Umbria Monitoraggio Ambulatoriale) study, pre-treatment glucose levels and use of diuretic drugs were independent predictors of new-onset diabetes. Although there is some controversy on this topic, prevention of new-onset diabetes could contribute to explain at least part of the benefit attributed to ACE inhibitors, calcium-channel blockers and angiotensin II receptor blockers in some intervention trials. In clinical practice, when faced with subjects at high risk of diabetes, it is important to implement nonpharmacological strategies whenever appropriate (diet, physical activity, weight loss). In these subjects, ACE inhibitors, calcium-channel blockers and angiotensin II receptor blockers could be considered first-line drugs. [ABSTRACT FROM AUTHOR]