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Purpose: Previous research has suggested that prescribers' knowledge of drug costs in Ireland is deficient. We aimed to update this finding by asking prescribers to estimate drug costs for low-and high-cost drugs, as well as examining their familiarity with a national prescribing initiative. Methods: We conducted a survey of five groups of prescribers and one group of medical students asking them to estimate the drug costs. Drugs recommended by the Preferred Drugs Initiative in Ireland were included, as were high-cost monoclonal antibody products and nutrition supplements. A 25% margin of error was allowed for a correct estimate. Comparisons were performed across participant groups and between drugs. A number of qualitative questions were included to provide context. Results: The survey received 122 responses. General practitioners (GPs) had the most accurate estimates, with medical students having the least. The percentage with a correct estimate was lower for higher cost drugs across all participant groups. GPs were also most certain about the estimates and most familiar with the Preferred Drug Initiative, while the students rated worst for both these questions. The cost of most drugs was overestimated. Most prescribers were uncertain about their estimates, which was reflected by the large variation in estimates. Eighty-three percent of prescribers would consider a trade-off of drug efficacy for affordability at least sometimes. Conclusions: Prescribers' knowledge of drug costs in Ireland remains poor and may negatively affect patient outcomes and national drug budgets. A national program provides recommendations to improve cost-effective prescribing; however, further alterations to national prescribing practices and policies are required to raise awareness of drug costs and these recommendations. [ABSTRACT FROM AUTHOR]

Background: Angiotensin-converting enzyme inhibitors and calcium channel blockers in combination are widely recommended in hypertension guidelines. The advantages of single-pill combinations (SPCs) are increasingly recognized, so a dosage-adapted combination of perindopril and amlodipine was developed for the initial management of hypertension. Objective: This randomized trial evaluated the blood pressure (BP)-lowering efficacy of four incremental doses of perindopril/amlodipine SPC in adults with mild-to-severe hypertension. Methods: Eligible patients (N = 1617) were randomized to SPC perindopril 3.5 mg/amlodipine 2.5 mg (i.e., 3.5/2.5 mg) daily, uptitrating as required on a monthly basis up to 14/10 mg until BP < 140/90 mmHg (< 130/80 mmHg in patients with diabetes). The primary endpoint (proportion with controlled BP at each uptitrated dose) was evaluated at 6 months, and safety was evaluated at 9 months; 24-h ambulatory BP measurement and BP variability were also investigated. Control-arm participants (n = 1653) were randomized to irbesartan 150 mg daily, uptitrating over 3 months to irbesartan/hydrochlorothiazide 300/25 mg. Results: Significant increases in BP control were observed with each dosage increment of perindopril/amlodipine, which was well tolerated, rising from 21% (3.5/2.5 mg) to 30% (7/5 mg), 37% (14/5 mg), and 42% (14/10 mg) after 1, 2, 3, and 6 months, respectively. Reductions in mean systolic and diastolic BP occurred with each incremental dose of perindopril/amlodipine. After 6 months, mean BP had fallen by 24.8/10.8 mmHg. Irbesartan-based therapy reduced clinic and 24-h BP similarly to perindopril/amlodipine, but perindopril/amlodipine reduced BP variability more in comparison. Conclusions: Incremental uptitration with dosage-adapted perindopril/amlodipine SPC is a safe and effective strategy for managing hypertension. Trial registration: EudraCT (No. 2006-005799-42). [ABSTRACT FROM AUTHOR]

Variability is a phenomenon common to most biological processes that we can measure and is a particular feature of blood pressure (BP). Variability causes concern for many physicians regarding its clinical meaning and potential impact on cardiovascular risk. In this review, we assess the role of different time periods of blood pressure variability (BPV) in cardiovascular risk stratification. We review the indices of BPV derived from ambulatory blood pressure measurement (ABPM), home blood pressure measurement (HBPM), or at the clinic setting with the intention of providing a clear message for clinical practice. BPV, either derived from ABPM or HBPM, does not consistently augment cardiovascular risk prediction over and beyond that of average BP, particularly in low-risk individuals. That said, it would seem that certain medications such as calcium channel blockers may have a beneficial effect on visit-to-visit BPV and perhaps reduce the associated cardiovascular risk. This highlights the benefits in using combination therapy which might couple a number of therapeutic benefits such as the reductions of mean blood pressure and BPV. Overall, we should remain aware that the average BP level remains the main modifiable risk factor derived from BP measurements and continue to improve the control of hypertension and adverse health outcomes. [ABSTRACT FROM AUTHOR]

mbulatory blood pressure (BP) monitoring is increasingly used in the evaluation of hypertensive patients. The ability to monitor BP throughout the day and night allows the detection of abnormal nocturnal BP patterns, the most common being a 'nondipping' pattern, which is associated with increased cardiovascular risk; its correction appears to have a positive impact on cardiovascular outcome. Antihypertensive treatment should be individually adjusted to control BP during both daytime and nighttime. However, drug-induced lowering of nocturnal BP, if excessive, could amplify the morning BP surge in patients with daytime BP elevation, increasing the risk of developing a cardiovascular event. Ambulatory BP monitoring therefore represents a unique tool to establish the most appropriate antihypertensive drug regimen for the individual patient. [ABSTRACT FROM AUTHOR]

Background The lowering of cholesterol concentrations in individuals at high risk of cardiovascular disease improves outcome. No study, however, has assessed benefits of cholesterol lowering in the primary prevention of coronary heart disease (CHD) in hypertensive patients who are not conventionally deemed dyslipidaemic. Methods Of 19 342 hypertensive patients (aged 40--79 years with at least three other cardiovascular risk factors) randomised to one of two antihypertensive regimens in the Anglo-Scandinavian Cardiac Outcomes Trial, 10 305 with nonfasting total cholesterol concentrations 6.5 mmol/L or less were randomly assigned additional atorvastatin 10 mg or placebo. These patients formed the lipid-lowering arm of the study. We planned follow-up for an average of 5 years, the primary endpoint being non-fatal myocardial infarction and fatal CHD. Data were analysed by intention to treat. Findings Treatment was stopped after a median follow-up of 3.3 years. By that time, 100 primary events had occurred in the atorvastatin group compared with 154 events in the placebo group (hazard ratio 0.64 [95% CI 0.50--0.83], p = 0.0005). This benefit emerged in the first year of follow-up. There was no significant heterogeneity among prespecified subgroups. Fatal and non-fatal stroke (89 atorvastatin vs 121 placebo, 0.73 [0.56--0.96], p = 0.024), total cardiovascular events (389 vs 486, 0.79 [0.69--0.90], p = 0.0005), and total coronary events (178 vs 247, 0.71 [0.59--0.86], p = 0.0005) were also significantly lowered. There were 185 deaths in the atorvastatin group and 212 in the placebo group (0.87 [0.71--1.06], p = 0.16). Atorvastatin lowered total serum cholesterol by about 1.3 mmol/L compared with placebo at 12 months, and by 1.1 mmol/L after 3 years of follow-up. Interpretation The reductions in major cardiovascular events with atorvastatin are large, given the short follow-up time. These findings may have implications for future lipid-lowering guidelines. Lancet 2003; 361: 1149--58. Published online April 2, 2003 http://image.thelancet.com/extras/03art3046web.pdf see Commentary Page 1144 [ABSTRACT FROM AUTHOR]

Focuses on the research conducted by Manning G. Rushton and her colleagues on the concept of white coat hypertension in clinical medicine. Explanation of the concept; Diagnosis of white coat hypertension; Recommendation to perform echocardiography in patients with white coat hypertension.

Focuses on Anglo-Scandinavian Cardiac Outcomes Trial study by members of Sub-study committee. Scientific issues to be answered by the study; Reasons provided for publishing protocols for the sub-studies in a supplement volume; Support provided by pharmaceutical companies and grant awarding bodies to the study.