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Abstract Background Lipid-lowering drugs and antihypertensive drugs are commonly combined for cardiovascular disease (CVD). However, the relationship of combined medications with CVD remains controversial. We aimed to explore the associations of genetically proxied medications of lipid-lowering and antihypertensive drugs, either alone or both, with risk of CVD, other clinical and safety outcomes. Methods We divided 423,821 individuals in the UK Biobank into 4 groups via median genetic scores for targets of lipid-lowering drugs and antihypertensive drugs: lower low-density lipoprotein cholesterol (LDL-C) mediated by targets of statins or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, lower systolic blood pressure (SBP) mediated by targets of β-blockers (BBs) or calcium channel blockers (CCBs), combined genetically lower LDL-C and SBP, and reference (genetically both higher LDL-C and SBP). Associations with risk of CVD and other clinical outcomes were explored among each group in factorial Mendelian randomization. Results Independent and additive effects were observed between genetically proxied medications of lipid-lowering and antihypertensive drugs with CVD (including coronary artery disease, stroke, and peripheral artery diseases) and other clinical outcomes (ischemic stroke, hemorrhagic stroke, heart failure, diabetes mellitus, chronic kidney disease, and dementia) (P > 0.05 for interaction in all outcomes). Take the effect of PCSK9 inhibitors and BBs on CVD for instance: compared with the reference, PCSK9 group had a 4% lower risk of CVD (odds ratio [OR], 0.96; 95%CI, 0.94–0.99), and a 3% lower risk was observed in BBs group (OR, 0.97; 95%CI, 0.94–0.99), while combined both were associated with a 6% additively lower risk (OR, 0.94; 95%CI, 0.92–0.97; P = 0.87 for interaction). Conclusions Genetically proxied medications of combined lipid-lowering and antihypertensive drugs have an independent and additive effects on CVD, other clinical and safety outcomes, with implications for CVD clinical practice, subsequent trials as well as drug development of polypills.

Abstract Background Improving adherence to antihypertensive medication (AHM) is a key challenge in hypertension management. This study aimed to assess the impact of ambulatory blood pressure monitoring (ABPM) on AHM adherence. Methods We utilized the Korean National Health Insurance Service database. Among patients newly diagnosed with hypertension who started AHM between July 2010 and December 2013, we compared clinical characteristics and adherence between 28,116 patients who underwent ABPM prior to starting AHM and 118,594 patients who did not undergo ABPM. Good adherence was defined as a proportion of days covered (PDC) of 0.8 or higher. Results The total study population was 146,710, with a mean age of 50.5 ± 6.4 years; 44.3% were female. Co-morbidities were noted in 4.2%. About a third of patients (33.1%) showed good adherence. The ABPM group had a notably higher PDC (total PDC: 0.64 ± 0.35 vs. 0.45 ± 0.39; P

Abstract Background Mental disorders are among the top causes of disease burden worldwide. Existing evidence regarding the repurposing of antihypertensives for mental disorders treatment is conflicting and cannot establish causation. Methods We used Mendelian randomization to assess the effects of angiotensin-converting-enzyme inhibitors (ACEIs), beta blockers (BBs), and calcium channel blockers (CCBs) on risk of bipolar disorder (BD), major depression disorder (MDD), and schizophrenia (SCZ). We used published genetic variants which are in antihypertensive drugs target genes and correspond to systolic blood pressure (SBP) in Europeans and East Asians, and applied them to summary statistics of BD (cases = 41,917; controls = 371,549 in Europeans), MDD (cases = 170,756; controls = 329,443 in Europeans and cases = 15,771; controls = 178,777 in East Asians), and SCZ (cases = 53,386; controls = 77,258 in Europeans and cases = 22,778; controls = 35,362 in East Asians) from the Psychiatric Genomics Consortium. We used inverse variance weighting with MR-Egger, weighted median, weighted mode, and Mendelian Randomization Pleiotropy RESidual Sum and Outlier. We performed gene-specific analysis and utilized various methods to address potential pleiotropy. Results After multiple testing correction, genetically proxied ACEIs were associated with an increased risk of SCZ in Europeans (odds ratio (OR) per 5 mmHg lower in SBP 2.10, 95% CI 1.54 to 2.87) and East Asians (OR per 5 mmHg lower in SBP 2.51, 95% CI 1.38 to 4.58). Genetically proxied BBs were not associated with any mental disorders in both populations. Genetically proxied CCBs showed no benefits on mental disorders. Conclusions Antihypertensive drugs have no protection for mental disorders but potential harm. Their long-term use among hypertensive patients with, or with high susceptibility to, psychiatric illness needs careful evaluation.

AbstractBackground Globally, the prevalence of hypertension and the accompanying burden of cardiovascular disease are increasing. Through drug utilization research, we can understand the prescription status of hypertension patients and promote rational drug use. The purpose of this retrospective study was to describe the current prescription pattern of antihypertensive drugs in Chinese patients and determine the compliance level of treatment guidelines.Materials and methods Around 11.1 million patients who received a prescription for antihypertensive therapy between January 2021 to December 2021 were obtained from a database of Hangzhou Kang Sheng Health Consulting CO., Ltd.Results The mean age of hypertensive patients was 54.75 ± 12.98 years. About 6.7 million (60.30%) were males. About 46.07% of patients had comorbidities. The most common classes of antihypertensive medications used were calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs). Around 78.33% of participants were on monotherapy. Diuretics + ARBs and Diuretics + CCBs + ARBs were the most commonly prescribed pattern in two-drug combination therapy and three-drug combination therapy, respectively.Conclusions CCBs and ARBs were the two most frequently prescribed for patients with hypertension. The prescription pattern of antihypertensive medications in the study largely complied with recommended Chinese hypertension guidelines.Key messagesCardiovascular disease is the most common complication of hypertension.Calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs) are the two most commonly used drugs for hypertension patients in China.The proportion of combination prescription pattern in Chinese hypertensive patients is low.

Resistant hypertension (RHTN) prevalence ranges from 4 to 19% in Africa. There is a paucity of data on the role of genetic variation on RHTN among Africans. We set out to investigate the role of polymorphisms in ABCB1, ADRB1, CYP3A4, CYP3A5, NEDD4L, and NR3C2, on RHTN susceptibility among South Africans. Using a retrospective matched case–control study, 190 RHTN patients (cases: blood pressure (BP) ≥ 140/90 mmHg on ≥3 anti-hypertensives or BP < 140/90 mmHg on >3 anti-hypertensives) and 189 non-RHTN patients (controls: CYP3A5 rs776746C/C genotype (p = 0.02; OR: 0.44; CI: 0.22–0.89) was associated with reduced risk for RHTN. Homozygous ADRB1 rs1801252G/G (p = 0.02; OR: 3.30; CI: 1.17–10.03) and NEDD4L rs4149601A/A genotypes (p = 0.001; OR: 3.82; CI: 1.67–9.07) were associated with increased risk for RHTN. Carriers of the of ADRB1 rs1801252—rs1801253 G–C haplotype had 2.83-fold odds of presenting with RHTN (p = 0.04; OR: 2.83; CI: 1.05–8.20). These variants that are associated with RHTN may have clinical utility in the selection of antihypertensive drugs in our population.

Abstract Background Associations between blood pressure (BP) with age at onset of Huntington’s disease (HD) have reported inconsistent findings. We used Mendelian randomization (MR) to assess effects of BP and lowering systolic BP (SBP) via the genes encoding targets of antihypertensive drugs on age at onset of HD. Methods Genetic variants from genome-wide association studies(GWAS) of BP traits and BP-lowering variants in genes encoding antihypertensive drugs targets were extracted. Summary statistics for age at onset of HD were retrieved from the GWAS meta-analysis of HD residual age at onset from the GEM-HD Consortium included 9064 HD patients of European ancestry (4417 males and 4,647 females). MR estimates were calculated using the inverse variance weighted method, supplemented by MR-Egger, weighted median, and MR-PRESSO methods. Results Genetically predicted SBP or diastolic BP increase was associated with a later age at onset of HD. However, after SBP/DBP was present as a covariate using multivariable MR method, no significant causal association was suggested. A 10-mm Hg reduction in SBP through variants in genes encoding targets of calcium channel blockers (CCB) was associated with an earlier age at onset of HD (β=-0.220 years, 95% CI =-0.337 to -0.102, P = 2.42 × 10− 4). We did not find a causal association between angiotensin converting enzyme inhibitors and β-blockers with the earlier HD onset. No heterogeneity and horizontal pleiotropy were identified. Conclusions This MR analysis provided evidence that genetically determined SBP lowering through antihypertensive drugs might be associated with an earlier age at onset of HD. The results may have a potential impact on management of hypertension in the pre-motor-manifest HD population.

Every year in the world, arterial hypertension is the cause of death in about 9 million cases. Blood pressure control in patients has not yet reached the appropriate level, and the percentage of resistant arterial hypertension remains high. According to the definition of the American Heart Association, those patients whose condition requires taking four or more drugs to control blood pressure should be considered resistant to treatment. It should be understood that uncontrolled hypertension is not synonymous with RAH. The presence of RAH significantly increases the risk of cardiovascular complications, contributes to serious damage to target organs. Preliminary diagnosis of RAH definitely requires the exclusion of secondary hypertension, which is a rather heterogeneous group of diseases that is poorly recognized. The goal of the work. To acquaint general practice - family medicine doctors with the algorithm of treatment of patients with resistant arterial hypertension at the ambulatory stage. Treatment of patients with RAH should be carried out in stages, with increased therapy, using the most simplified scheme of taking drugs. Today, the combination of ACEI (perindopril), BCC (amlodipine) and diuretic (indapamide) is considered as the most optimal triple combination of antihypertensive drugs. Medicines containing three antihypertensive drugs in one tablet are offered precisely for RAH patients. Conclusions. The implementation of the algorithm for the examination of patients with RAH, recommendations for changing their lifestyle and a step-by-step therapy plan allow improving the control of blood pressure. Treatment of patients with RAH should include optimization of dosages and the appointment of rational combinations of antihypertensive drugs in order to enhance synergistic effects. Optimization of pharmacotherapy by prescribing drugs with fixed combinations can improve control of drug administration. The fixed combination of amlodipine-indapamide-perindopril may have the important advantage of increasing treatment adherence due to the principle of "one pill per day".

Adherence of patients to antihypertensive drugs refers to the extent to which their taking corresponds with agreed recommendations from a health care provider. The goal was to measure adherence and examine the association with socio-demographic and medication status variables. A cross-sectional pilot study was conducted with 120 respondents, aged ≥ 18 years, who are being treated for hypertension and who visited the ambulance of family physician at Primary Health Care Centre Cetinje in April and May 2022. A questionnaire with socio-demographic and medication status and the Hill-Bone scale was used. Adherence was categorized as good (≥ 80%) and worse (< 80%). The age of respondents was 64,6 ± 9,28. The majority were female, married, with a high school diploma, retired and treated for hypertension for ≥ 11 years. The total number of drugs in regular therapy was 6,1 ± 2,85 and antihypertensive 2,24 ± 0,85. 14,2% of respondents suspected the side effects of antihypertensive drugs and the majority participate in their costs. The number of points on the Hill-Bone scale was 10,04 ± 1,90 and 95% of respondents had good adherence. Of all the variables, a statistically significant association was found only for participation in the costs of antihypertensive drugs. The obtained results support the view that patients' personal beliefs about the necessity of taking therapy and the concerns of side effects are better predictors of adherence than other factors.

Aim. To analyze the effect of dosed endotrabeculectomy in combination with non-penetrating deep sclerectomy on the level of intraocular pressure (IOP) and aqueous humor outflow from the anterior chamber. Materials and methods. The study involved 12 patients (12 eyes) who underwent dosed endotrabeculectomy with ab interno approach in combination with non-penetrating deep sclerectomy surgery. All the patients had moderate or severe trabecular pigmentation by gonioscopy. The follow-up period was 12 months. Measurement of IOP was performed according to Maklakov before and after surgery (on the 7th day, 1st, 3rd, 6th and 12th month). Tonography was performed according to Nesterov (using the simplified method) at the same time periods. The outflow facility coefficient and Becker’s coefficient were determined. The number of local antihypertensive agents used within that period was also observed. A combined drug was counted as two – according to the number of active substances. Results. The difference between preoperative and postoperative IOP was found to be significant up to and including the 12th month. IOP at the 6th month after surgery was 8.67 mm Hg lower and at the 12th month – 7.83 mm Hg lower. The outflow facility coefficient was significantly increased from 0.14 ± 0.06 mm3/mm Hg/min up to 0.32 ± 0.03 mm3/mm Hg/min (P < 0.05). Becker’s coefficient was significantly decreased from 157.80 ± 8.04 to 42.2 ± 3.6 (P < 0.05). Conclusions. Dosed endotrabeculoectomy in combination with non-penetrating deep sclerectomy has shown the significant hypotensive effect, as well as the increase in outflow facility coefficient and the decrease in Becker’s coefficient during the postoperative period among patients with primary open-angle glaucoma within the 12-month follow-up.

Aim. To analyze therapy in patients with arterial hypertension (AH) in 20102020. Materials and methods. Data of hypertensive patients observed in primary health care, entered into the base of hypertension registry for 20102020 years in the whole group (n=44 653) and in a separate subgroup of hypertensive patients in the absence of: ischemic heart disease, a history of myocardial infarction, chronic heart failure (n=20 569). Results. About 80% of hypertensive patients are patients of high and very high risks (from 2010 to 2020, the proportion of very high cardiovascular risk (CVR) increased from 18.1 to 57.3%). The number of hypertensive patients with a history of myocardial infarction increased in 5 times, in 3 times with ischemic heart disease and with chronic heart failure. The number of prescribed drugs increased: mineralocorticoid receptor antagonist (in 5.8 times), loop diuretics (in 7.2) angiotensin receptor blockers (in 3 times), b-adrenoblockers, calcium channel blockers of the dihydropyridine series, thiazide-like diuretics in 2 times. Patients at high and very high risk are more likely reached target blood pressure values. Angiotensin-converting enzyme inhibitors were prescribed in more than 70% of patients with hypertension and the absence of coronary heart disease, chronic heart failure, history of myocardial infarction; the prescription of b-adrenoblockers, angiotension receptor blockers, thiazide-like and loop diuretics increased. Conclusion. The proportion of more severe and comorbid patients has increased in observed in primary health care patients with AH over a 10-year period (20102020). This was probably the main factor of increasing antihypertensive therapy and prescribing drugs with additional indications and improving the achievement of target blood pressure in patients with high and very high cardiovascular risk.

Background. The main factors that increase the risk of cardiovascular accidents and mortality among patients with COVID-19 include hyperglycemia, arterial hypertension and dyslipidemia. Therefore, all patients with COVID-19 and metabolic syndrome should receive antihypertensive (AHT), hypolipidemic (GLT) and hypoglycemic therapy (GGT). Currently, there is a limited number of studies regarding the effectiveness and safety of this therapy in patients with COVID-19. Aim. Evaluate the clinical outcomes of patients with COVID-19, depending on the recipient of AHT, GLT and GGT. Materials and methods. A retrospective analysis of the clinical outcomes "discharged/died" of 1753 patients with COVID-19 was carried out depending on the received AHT, GLT and GGT. Results. A significant reduction in the risk of mortality among patients with COVID-19 was observed during therapy with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers ACE inhibitors/ARBs (OR 0.39, 95% CI 0.210.72; p0.05) and b-adrenergic blockers b-AB (OR 0.53, 95% CI 0.281; p0.05). At the same time, against the background of therapy with ACE inhibitors/ARBs and b-ABs, the chance of mortality decreased more significantly among patients with type 2 diabetes mellitus (T2DM) compared with patients without T2DM. Diuretic therapy was associated with a 3-fold increase in the chances of death: OR 3.33, 95% CI 1.884.79; p0.05. Statin therapy did not affect clinical outcomes in COVID-19 patients. On the background of therapy with oral hypoglycemic drugs, the risk of mortality decreased 5-fold (OR 0.19, 95% CI 0.070.54; p0.05). Against the background of insulin therapy, there was an increase in mortality risk by 2.8 times (OR 2.81, 95% CI 1.55.29; p0.05). Conclusion. A significant reduction in mortality among patients with COVID-19 was observed during therapy with ACEI/ARB, b-AB, and oral hypoglycemic therapy. Increased risk of death was associated with insulin therapy and diuretic therapy.

(1) Background: This study was planned to assess the concentration of antihypertensive drugs (AHD) in the blood serum in patients with controlled and uncontrolled arterial hypertension (AH). (2) Methods: We assessed 46 patients with AH. Based on the results of 24 h blood pressure monitoring (ABPM), the patients were randomized into two groups. The first group consisted of the patients with controlled AH; the second group consisted of the patients with uncontrolled AH. Venous blood was taken in both groups of patients in the morning before and 2 h after taking drugs to assess the concentration of lisinopril, amlodipine, valsartan, and indapamide. (3) Results. The first group included 27 patients, and the second group 19 patients. In patients with uncontrolled AH, the median concentrations of lisinopril, indapamide, amlodipine, and valsartan before and after taking the drugs did not differ from patients who reached the target BP values. (p > 0.05). In some patients with uncontrolled and controlled (shown for the first time) AH the concentration of AHD was below the limit of quantitative determination. (4) Conclusions. The obtained results indicate that the pharmacokinetics of AHD, apparently, does not play a significant role in the development of ineffectiveness of the ongoing therapy for AH. Therapeutic drug monitoring can be used to test adherence to the treatment.

Background: Adherence to antihypertensive therapy is an important factor in determining the clinical course of hypertension. This study was planned to estimate adherence to antihypertensive therapy and its determinants among OPD patients attending two primary care hospitals in Kashmir valley. Methods: This study employed a cross-sectional study design. All subjects who reported to OPD between October and December 2020 and had been prescribed antihypertensive medications for at least 1 year were included. Sociodemographic information was collected on a pretested schedule and adherence to medications was assessed by using the-14 item Hill-Bone HBP Compliance to High Blood Pressure Therapy Scale (HB-HBP). Mann–Whitney test and Spearman's rank correlation coefficient were used. Results: A total of 406 subjects were included in the final analysis with a mean age of 58 years for women and 56 years for men. The sample comprised 54% women. More than 60% of subjects were currently married, urban area residents, and belonged to middle strata of social class. The mean score obtained in the HB-MAS (maximum score 56) was 19.26 (SD ± 4.3). Subjects aged 60 years and above, those belonging to lower socioeconomic class, and subjects prescribed three or more drugs with more than once-daily dosing regimen had higher odds of having poor adherence. Conclusion: There is suboptimal adherence among OPD patients at primary care level. There is a need for enhanced counselling regarding medication adherence particularly for elderly, poor, illiterate persons and those prescribed multiple medicines with more than once-daily dosing.

Introduction: Aortic dissection (AD) is a life-threatening disease. However, the effectiveness of different strategies of antihypertensive therapies in non-operated AD patients is still unclear. Materials and methods: Patients were classified into five groups (groups 0–4) based on the number of classes of antihypertensive drugs, including β-blockers, renin-angiotensin system (RAS) agents (angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and the renin-inhibitors), calcium channel blockers (CCBs), and other antihypertensive drugs, were prescribed within 90 days after discharge. The primary endpoint was a composite outcome of re-hospitalization associated with AD, referral for aortic surgery, and all-cause death. Results: A total of 3932 non-operated AD patients were included in our study. The most prescribed antihypertensive drugs were CCBs, followed by β-blockers and ARBs. Within group 1, compared to other antihypertensive drugs, patients using RAS agents (aHR, 0.58; p = 0.005) had a significantly lower risk of occurrence of the outcome. Within group 2, the risk of composite outcomes was lower in patients using β-blockers + CCBs (aHR, 0.60; p = 0.004) or CCBs + RAS agents (aHR, 0.60; p = 0.006) than in those using RAS agents + others. Conclusion: For non-operated AD patients, RAS agents, β-blockers, or CCBs should be given in a different strategy of combinations to reduce the hazard of AD-related complications compared to other agents.

Background: Hypertension is leading cause of deaths in the world. It is a modifiable and major risk factor for cardiovascular, renal and brain diseases. This study was done to see the current trend of prescription patterns of antihypertensive drugs in a tertiary care hospital in Nepal. Materials and Methods: Observational cross sectional study was done in the patients with hypertension from September 2018 to September 2019 in the department of Medicine of Civil Service Hospital, a tertiary care hospital in Kathmandu, Nepal. A total of 242 Patients who were undergoing antihypertensive treatment were included. All calculations and statistical analyses are processed by the SPSS 25.0. Results: Out of 242 prescriptions, 135(55.8%) were males, and 107(44.2%) were females. Among them, 49 (20.2%) patients had controlled Blood Pressure, 63(26%) patients had hypertension stage I and the remaining 130 patients (53.7%) patients had stage II hypertension. In the present study, 133 (54.96%) were treated with monotherapy while, 71 (29.33%) patients were prescribed with dual therapy. The most frequently prescribed drug as monotherapy was Calcium Channel Blocker in 71(53.3%) patients followed by Angiotensin Receptor Blockers in 38 (28.6%) and thiazide diuretics in 21 (15.7%) patients. Calcium Channel Blockers with Angiotensin Receptor Blockers was the most prescribed combination in 44 (62.1%) patients followed by Angiotensin Receptor Blockers and Thiazide Diuretics in 19 (26.8%) patients. Conclusion: Calcium channel blockers are the highest among the drugs that are used as monotherapy. In combination therapy, Calcium channel blockers with angiotensin receptor blocker and angiotensin receptor blockers with thiazide diuretics are the frequently prescribed drugs.

A present review is devoted to the current state of the problem of blood pressure variability (BPV) in hemodialysis patients. The BPV classification and clinical significance of BPV metrics are discussed. The results of cohort and randomized studies on the high BPV influence on outcomes in hemodialysis patients, as well as on the possibilities of antihypertensive drugs in the treatment of high BPV in dialysis patients, are presented.

The aim of study was to analyze and investigate the severity of adverse reactions (AR) on drugs used for arterial hypertension treatment in patients living in the Republic of Crimea for the period 2011—2016.Materials and methods. We studied notification cards about AR registered in the regional database of spontaneous messages ARCADe. We analyzed 211 notification cards about AR in patients with proven arterial hypertension diagnosis (ICD code П0—П5).Results. Drugs from the groups of angiotensin-converting enzyme inhibitors and slow calcium channel blockers most often cause AR, among them enalapril and amlodipine are the absolute leaders. AR occurred less frequently in application of drugs from the groups of в-blockers and angiotensin IIreceptor blockers. The study of the clinical manifestations of AR showed that most of them were allergic reactions of varying severity (skin itch, urticaria, swelling of lips, eyelids, tongue). The number of such cases was 70 (33.2 %) from all registered cases of AR on antihypertensive drugs. Examination of the outcomes of AR in patients taking antihypertensive drugs showed that the development of temporary disability was observed in 19 (9 %) cases, the hospitalization of outpatients as a result of AR development on drugs was required in 7 (3.3 %) cases, and in 2 cases patients had to prolong hospitalization. Life-threatening conditions in the form of Quincke’s edema were reported in 13patients. In the remaining 170 (80.6 %) cases AR were not serious and did not cause the above consequences. Assessment of AR severity revealed that mild AR were most common, much less often antihypertensive drugs caused severe AR (the incidence ranged from 5 to 13 %, depending on the method for severity assessment).Conclusion. The obtained results confirm our previously published data that in the structure of AR on antihypertensive drugs, bulk of the reports associated with angiotensin-converting enzyme inhibitors. Most often antihypertensive drugs caused mild AR.

The prevalence of cardiovascular diseases, especially arterial hypertension, continues to increase. An important problem is the management of the patient with a comorbid pathology in the primary link by the family physician. The purpose of this study was to assess the state of medical care in patients with arterial hypertension combined with gout, using a retrospective analysis of ambulatory cards, diagnostic and treatment data. There were analyzed 105 outpatient cards that met the inclusion criteria. The mean age of patients was 53.5±10.2 years. Among the examined patients there were 99 males (94.3%), and 6 (5.7%)females. Аrterial hypertension stage II has been reported in 100 (95.2%) patients, stage III – 5 (4.8%) patients. Аrterial hypertension 1 degree is established in 74 (70,5%) patients, 2 degrees – 21 (20%), 3 degrees – 10 (9,5%). The average duration of the gout was 4.4 [4; 2] years, arterial hypertension – 5.3 [3; 1] years. Acute gouty arthritis was present in 11 (10.5%) patients, chronic gouty arthritis – 85 (81%), and chronic tofi arthritis – 9 (8.5%). Patients seek medical help from their family doctor too late. Examination of patients with hypertension in combination with gout is not complete, this contributes to underestimation of total cardiovascular risk. In a number of cases, titration of the dose of allopurinol higher than 300 mg is not, performed so only a third of patients reach the target uric acid level.

INTRODUCTION: Several international guidelines are available on drug treatment for hypertension, but the control of hypertension remains very poor in sub-Saharan Africa (SSA). We investigated the commonly prescribed antihypertensive drugs and their association with blood pressure (BP) control in adult Cameroonians. METHODS: we consecutively recruited hypertensive outpatients attending the Buea and Limbe Regional Hospitals (Southwest Region of Cameroon). Controlled BP was defined as BP 140/90mmHg in hypertensive patients aged 60 years or younger, diabetics or patients with chronic kidney disease or a BP 150/90mmHg in non-diabetic hypertensive patients older than 60 years of age (JNC8). RESULTS: of the 408 participants included (mean age 61.1 years), 67% were female. The median duration of hypertension was 6 years and the median duration of the current treatment was 22 weeks. Commonly prescribed antihypertensives were calcium channel blockers (CCB, 35.1%), thiazide/thiazide-like diuretics (TD/TLD, 26.1%) and angiotensin-converting enzyme inhibitors (ACEI,19.5%). The median monthly cost of antihypertensive was 10279.6 CFA (approximately equal to US$ 172). 70% of participants were receiving at least 2 drugs, with ACEI+TD/TLD, CCB+TD/TLD, and ACEI+CCB+TD/TLD being the most frequent. The rate of BP control was 52% overall, and 60% in participants on monotherapy. CONCLUSION: CCBs were the most prescribed single antihypertensive drugs in this setting while ACEI+TD/TLD was the most common combination. About half of patients were at target BP control levels Improving availability and affordability of these medications may improve hypertension management and control.

Patients who are unable to receive oral medication (p.o.) are a major problem in outpatient settings, especially in home health care systems. Mucosal administration of drugs offers an alternative to the oral route, especially when the parenteral mode cannot be used. There are three main pathways of mucosal administration: sublingual/buccal, intranasal and rectal. We discuss the possibility of mucosal delivery of antihypertensive drugs. Perindopril arginine and Amlodipine besylate are registered in the EU as orodispersible tablets for oromucosal delivery, however, they are not available in all countries. For this reason, we describe other drugs suitable for mucosal delivery: Captopril and Nitrendipine in the sublingual system and Metoprolol tartrate, Propranolol and Furosemide by the transrectal route. Based on the published data and common clinical practice we discuss the use of mucosal delivery systems of all these antihypertensive drugs with special attention to their pharmacokinetics. We illustrate this mini-review with a case report of the prolonged-term use of mucosal delivery of sublingual Captopril and Nitrendipine combined with rectal Metoprolol tartrate and Furosemide in a patient with severe hypertension unable to receive medication p.o. This is also a report on the first human use of Furosemide-containing suppositories as well as prolonged-term transmucosal administration of these four drugs, describing a practical approach leading to successful control of severe hypertension with four antihypertensive drugs delivered via the mucosal route. The treatment was effective and without side effects; however, the long-term safety and efficacy of such therapy must be confirmed by randomized clinical trials.

Background: The rational use of medicines remains one of the most important directions of public health, especially in socio-medical diseases, including arterial hypertension. Material and methods: The study involved 28 cardiologists and 84 internists who, based on a set of questionnaires, expressed their opinion on ambulatory treatment of patients with arterial hypertension. Also 21 internists, 6 cardiologists and 6 obstetrician-gynecologists expressed their opinion on treatment of pregnancy-induced hypertension. Results: Cardiologists and internists recommended angiotensin-converting-enzyme inhibitors (ACE inhibitors) in 28% of cases, diuretics – in 23% of cases, beta-blockers (BB) – in 20, 4% of cases, calcium channel blockers (CCB) – in 13.7% of cases, angiotensin receptor blockers (ARB) – in 13.6% of cases for ambulatory treatment of patients with arterial hypertension. The antihypertensive drugs from other pharmacological groups (with central action, alpha-blockers, arteriodilators, sympatholytics, etc.) were prescribed in only 1.3% of patients. On treatment of hypertension in pregnancy showed that all physicians – 100% recommended as first-line agent for treatment of hypertension during pregnancy centrally acting antihypertensive drug Methyldopa. For second-line treatment they recommended CCB – in 36.36% of cases, alpha-adrenoblockers – in 24.24% of cases, BB – in 21.21% of cases, diuretics – in 12.12% of cases and 3% for ACE inhibitors and ARB. For treatment pre-eclampsia and eclampsia seizures in 84.85% of cases is recommended Magnesium sulfate and 15.15% mention labetalol, hydralazine and sodium nitroprusside. Conclusions: ACE inhibitors, diuretics, BAB, CCB and ARB have been first-line drugs in the arterial hypertension (AHT) treatment. For treatment of pregnancy-induced hypertension physicians recommended centrally acting antihypertensive drug Methyldopa. For second-line treatment they recommended calcium channel blockers (CCB), alpha-adrenoblockers, beta-blockers (BB) and diuretics. As third-choice in treatment of severe hypertension in preeclampsia are selected direct vasodilators as hydralazine, labetalol, sodium nitroprusside, and the most widely used in preeclampsia and eclampsia remains magnesium sulfate.

Aim: Drug–drug interactions (DDIs) are one of the major but preventable cause of adverse drug reaction. Study of prevalence and prediction of DDIs will make the physician easier to provide better patient care and mitigate patient's harm. Hence, the study was planned to evaluate the potential DDIs among medication prescribed to hypertensive patients in our hospital. Materials and Methods: A prospective, cross-sectional study was conducted among the hypertensive patients in medicine (outpatient/inpatient) department over the period of three months in a tertiary care hospital. Adult hypertensive patients of either sex with comorbidities were included in the study. The prescriptions were collected and analyzed for DDI using Medscape interaction checker. Data were analyzed using SPSS (version 16.0) software and expressed in percentage. Pearson's correlation and regression analysis were done. Results: Among 125 patients, 48% were exposed to at least one DDI. Totally 123 DDI were identified and majority of them were significant (85.36%). No serious interactions were identified. Pharmacodynamic and pharmacokinetic drug interactions were found to be 37.39% and 28.76%, respectively. Logistic regression analysis showed advanced male gender and polypharmacy was associated with increased risk of DDI. About 51 interacting pairs of DDI were identified and most frequently occurring pair was amlodipine with atenolol. Aspirin was found to have commonly involved in DDI with enalapril, atenolol, frusemide, spironolactone, carvedilol, and metoprolol. Conclusion: The study highlighted that patients with hypertension are particularly vulnerable to DDI. The comorbidities, advanced age, and polypharmacy are the important factors associated with the occurrence of DDI.

An important aspect of the family doctor's work is the management of patients with comorbid pathology. Pathogenetic mechanisms of interrelation, as well as the bi-directionality of the association of arterial hypertension and gout are actively studied. By data analysis of literature, in many developed countries of the world there are shortcomings in the management of patients with gout at the primary stage. There is a need to improve the quality of management and prescription of combinations of basic therapy drugs for the treatment of patients with hypertension in combination with gout at the primary stage.

Background: The number of patients with end-stage renal disease (ESRD) and the need for hemodialysis (HD) has increased and they needed repeated intervention to maintain access patency. Care of hemodialysis patients has considerable economic burden on health care system. The effects of antihypertensive medications on arteriovenous fistula (AVF) thrombosis are not clearly explained. This study aimed to evaluate the effects of continuing and discontinuing use of antihypertensive medications in peri-operative time on arteriovenous fistula thrombosis. Methods: This was a clinical trial study on 60 patients with ESRD and hypertension, candidates for hemodialysis that divided into two groups. The case group received their antihypertensive drug before surgery and the control group did not receive. Systolic, diastolic, and mean arterial blood pressure and heart rate were evaluated before and during surgery; the incidence of thrombosis immediately, 24 hours, and one week after surgery was evaluated as well. Findings: Patients with mean age of 58.85 ± 14.95 years were participated that 78.4% of them were men. The mean systolic blood pressure was higher in control group but this difference was just statistically significant before surgery and at the start of administering local anesthesia. Just before surgery, the mean diastolic blood pressure and mean arterial blood pressure were higher in control group significantly. The number of thrombosis in case group was higher significantly than control group immediately (P = 0.03), 24 hours (P = 0.04), and one week (P =0.02) after the surgery. Conclusion: Using antihypertensive medications in patients, candidates for arteriovenous fistula, increased the risk of arteriovenous fistula thrombosis.

Objective. To assess the frequency of prescribing of different groups of antihypertensive drugs (AHD) in the treatment of patients with arterial hypertension (AH) among patients of the Krasnoyarsk territory according to the Russian epidemiological studies ESSE-RF.Materials and methods. 1,603 persons aged 25–64 years, selected through systematic stratified multistage randomization among the population attached to the four outpatient clinics of Krasnoyarsk and Berezovsky district hospital were studied. All included subjects were subjected to a detailed survey of office blood pressure measurements. Results. The proportion of those on monotherapy was 53.4%. The most commonly accepted AHD, including in the combination therapy, were angiotensin-converting enzyme inhibitors (ACEI) – in 51% of cases, beta-blockers – 28.9 percent, angiotensin receptor blockers (ARBS) – 25,2%, diuretics – 23,2%, calcium channel blockers (CCB) – 11.9%, central action drugs – 2.0% and alpha-blockers – 0.4 percent. Beta-blockers often were taken by those of younger age – 38.1 per cent, mainly men aged 25–34 years (50.0 per cent). Among the combinations of AHD the most frequently encountered combination was ACEI + diuretic (6,8%), followed by rthe frequency of prescription by ARBS + diuretic, beta-blocker + diuretics, ARBS + CCB, ACE-I + CCB.Conclusion. The frequent prescription of ACE inhibitors and insignificant use of central action is noted. The high level of violence of use of AHD monotherapy in patients with hypertension (53,4%) is alarming, which may be one of the reason for the relatively low efficiency of antihypertensive therapy (31.6 percent). Beta-blockers were indicated unreasonably often for young men with hypertension aged 25–34 years.

Background: Antihypertensive drugs have been linked to new-onset osteoporotic fracture (NOF), and different classes of antihypertensive drugs may alter the risk for the development of NOF; however, the classic effect of different antihypertensive drugs on the development of NOF in the elderly has not been well studied during long-term follow-up. Methods: In this study, we investigated the association between different classic antihypertensives and the development of NOF in the elderly. This was a longitudinal cohort study performed using data from claim forms submitted to the Taiwan Bureau of National Health Insurance in Central Taiwan, China including case patients with NOF aged 65–80 years from January 2002 to December 2012 and non-NOF controls. Prescriptions for antihypertensives before the index date were retrieved from a prescription database. We estimated the hazard ratios (HR s) of NOF associated with antihypertensive use. Non-NOF controls served as the reference group. Results: A total of 128 patients with NOF were identified from among 1144 patients with hypertension during the study period. The risk of NOF after adjusting age, sex, comorbidities, and concurrent medications was higher among the users of angiotensin-converting enzyme (ACE) inhibitors (HR, 1.64; 95% confidence interval [CI], 1.01–2.66) than among nonusers. Patients who took calcium channel blockers (CCBs) (HR, 0.70; 95% CI, 0.49–0.99) were at a lower risk of developing NOF than nonusers. Loop diuretics, thiazide diuretics, angiotensin receptor blocker, beta-blocker, and alpha-blocker were not associated with the risk of NOF. Conclusions: Elderly with hypertension who take CCBs are at a lower risk of NOF and that the use of ACE inhibitors was associated with a significantly increased risk of developing NOF during the 11-year follow-up.

Purpose: Selection and use of anti-hypertensive agents are not usually compliant with international guidelines. A prescription based survey is the most effective method to assess and evaluate the prescribing pattern of physicians and dispensing practice of pharmacists; hence, the aim of this study was to assess the prescription pattern of anti-hypertensive drugs in Durame General Hospital. Material and Methods: A retrospective study was carried out from January to February, 2013 on one year patient cards. Records of 250 patients were selected by simple random sampling technique. However, since some of prescriptions are illegible and incomplete, 205 patient records were included in the study. Results: Out of 205 patients, 46 (22.44%) of them were on mono-therapy and 159 (77.56%) on combination therapy. Among patients on combination therapy, 120 (75.5%) and 39(24.5%) were on two and three drugs combination, respectively. Diuretic was the most frequently prescribed drug both as a single agent (65.22%) and as combination therapy (86.8%). Combination therapy significantly reduced blood pressure as compared to mono-therapy. The majority of co-prescribed drugs which have a potential drug interaction with anti-hypertensive agents were NSAIDs (98.21%). Conclusion: Combination therapy was the most prescribed pattern to treat hypertensive patients which is in line with international guidelines. However, majority of patients in pre-hypertensive stage were treated by combination therapy which is not recommended. Hence, physicians should consider when the combination drugs are to be prescribed for hypertensive patients. [Cukurova Med J 2015; 40(4.000): 698-706]

The potential of certain drugs to affect specific markers of progression of hypertension should be taken into account in the rational pharmacotherapy of arterial hypertension (AH) in patients with metabolic syndrome (MS). Pharmacodynamic effects of the beta-blocker (BB) nebivolol, the average daily dose 5,3 ± 2,5 mg, were studied in 29 patients with stage I - II hypertension with signs of MS (men - 15, women - 14; mean age 52, 4 ± 10,32 years). Nebivolol, along with a high antihypertensive efficacy (achievement of target blood pressure in 76% of patients) and good safety profile, provides a complex effect on specific markers of inflammation and disorders of carbohydrate metabolism. The study showed a decrease in the high-sensitivity C-reactive protein (hs-CRP) from 3.15 (2.0; 4.18) mg/l to 2.3 (1.18; 4.03) mg/l (p = 0.001), intercellular adhesion molecules (iCAM-1) from 330,23 (295.7; 387.3) ng/ml to 310.07 (252.72; 370.4) ng/ml (p = 0.044) with no adverse effect on insulin resistance, as well as a reduction in the adipokine activity and overall cardiovascular risk.

Currently, arterial hypertension (AH) and atherosclerosis are the most significant risk factors for cerebral complications including ischemic stroke, which requires adequate therapeutic interventions for primary and secondary prevention [1].

Background: Hypertension is a main risk factor for premature death. Although blood pressure is a complex trait, we have shown that the activity of the ATP-generating enzyme creatine kinase (CK) is a significant predictor of blood pressure and of failure of antihypertensive drug therapy in the general population. In this report, we systematically review the evidence on the association between this new risk factor CK and blood pressure outcomes. Method: We used a narrative synthesis approach and conducted a systematic search to include studies on non-pregnant adult humans that address the association between plasma CK and blood pressure outcomes. We searched electronic databases and performed a hand search without language restriction. We extracted data in duplo. The main outcome was the association between CK and blood pressure as continuous measures. Other outcomes included the association between CK and blood pressure categories (normotension and hypertension, subdivided in treated controlled, treated uncontrolled, and untreated hypertension). Results: We retrieved 139 reports and included 11 papers from 10 studies assessing CK in 34,578 participants, men and women, of African, Asian, and European ancestry, aged 18 to 87 years. In 9 reports, CK was associated with blood pressure levels, hypertension (vs. normotension), and/or treatment failure. The adjusted increase in systolic blood pressure (mmHg/log CK increase) was reported between 3.3 [1.4 to 5.2] and 8.0 [3.3 to 12.7] and the odds ratio of hypertension with high vs. low CK ranged between 1.2 and 3.9. In addition, CK was a strong predictor of treatment failure in the general population, with an adjusted odds ratio of 3.7 [1.2 to 10.9]. Discussion: This systematic review largely confirms earlier reports that CK is associated with blood pressure and failure of antihypertensive therapy. Further work is needed to address whether this new risk factor is useful in clinical medicine.

Aim. To collect information on the efficiency and safety of a fixed-dose combination of amlodipine/valsartan in patients who failed to achieve blood pressure (BP) control in the use of the combination of an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB) and a thiazide/thiazide-like diuretic. Subjects and methods. During routine clinical practice, the 12-week observation program covered 8594 hypertensive patients receiving a fixed-dose combination of amlodipine/valsartan 5/160, 10/160 mg (exforge, Novartis Pharma) with/without a diuretic. The inclusion criteria were 18 years of age or older; systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg) at the first visit; failure to achieve BP (≥140/90 mm Hg) control in the use of the combination of an ACE inhibitor or an ARB and a thiazide/thiazide-like diuretic; a patient's consent to participate in the program. The exclusion criteria were, besides the contraindications given in the drug use instruction, absent. Amlodipine/valsartan 5/160 or 10/160 mg were used after the previous ineffective therapy was discontinued. The patients visited their physician's office every 4 weeks. Results. The patients' baseline BP was 169.3/99.9 mm Hg. The risk of cardiovascular events was assessed as high in 38% of the patients and as very high in 43.1%. The previous therapy included thiazide or thiazide-like diuretics (92%), an ACE inhibitor (78.5%), an ARB (23.2%), Β-adrenoblockers (38.6%), calcium antagonists (23.1%), and other medications (25.5%). In the entire group, BP decreased from 169.3±15.6/99.9±9.3 to 129.1±9.1/80.3±6.4 mm Hg at the fourth visit. BP reductions at 12 weeks were 40.1±14.9/19.6±9.5 mm Hg. The therapy was effective in different treatment subgroups. At baseline, the majority of patients had grades 2 (53.1%) and 3 (35.4%) hypertension. At 12 weeks, 74% of the patients were found to have normal or high normal BP. Grade 3 hypertension was preserved only in 0.2% of the patients by the end of the program. BP goals were achieved in 79.5% of the patients. The therapy was well tolerated by the patients. Adverse reactions were observed in 3.1% of the patients and required treatment discontinuation in 0.5%. The most common side effect was peripheral edemas (1.4%). Conclusion. In the observation program AESCULAP using the fixed-dose combination of amlodipine/valsartan as different dosage regimens (5/160 and 10/160 mg) and/or a diuretic, there was a marked antihypertensive effect in different subgroups of patients with previously uncontrolled hypertension and the BP goals being achieved in 79.5% of cases. Most patients tolerated amlodipine/valsartan well and showed high compliance with the prescribed therapy. The rate of side effects in the AECULAP program was not greater than that (3.1%) in the earlier trials.

The present study represents the current prescribing trend for antihypertensive drugs in family medicine clinics at Jordan University Hospital in Jordan. The study sample involved 416 male and female hypertensive Jordanian patients. Our results demonstrate that 2 hypertensive patients were not receiving any antihypertensive therapy at the time of evaluation, 192 patients were on a single antihypertensive therapy, 157 patients were on two antihypertensive drugs, 52 patients were on triple antihypertensive therapy and 13 patients were on four or more drugs. The most frequent classes of antihypertensive drugs used or prescribed to patients either as a single therapy or in combinations include angiotensin converting enzyme inhibitors, β-blockers, calcium channel blockers, diuretics and angiotensin receptor blockers. Among the mono-therapy prescriptions, angiotensin converting enzyme inhibitors were the most commonly prescribed and diuretics were least used. In combined therapy, diuretics were the most prescribed antihypertensive drugs, followed by β-blockers. Combinations consisting of diuretics and β-blockers were the most commonly seen. With respect to overall use, angiotensin converting enzyme inhibitors were the most prescribed agents. Despite an observed significant reduction in blood pressure between first and last visits to the family clinics, most of the patients did not achieve recommended blood pressure control according to the international guidelines. [Med-Science 2013; 2(1.000): 469-88]

Resumen INTRODUCCIÓN La hipertensión arterial requiere de intervenciones efectivas para reducir la morbimortalidad cardiovascular. Las terapias farmacológicas han logrado alcanzar cifras óptimas de presión arterial en los afectados. En las guías clínicas recientes se sugiere la utilización de las combinaciones de medicamentos, esto ha llevado a elaborar una diversidad de combinaciones a dosis fija. OBJETIVO Buscar la mejor evidencia bibliográfica disponible sobre la efectividad de los medicamentos antihipertensivos en combinaciones a dosis fija, en comparación con combinaciones a dosis separadas para controlar la presión arterial, la adherencia al tratamiento y disminución de la morbimortalidad cardiovascular. MÉTODOS Se realizó una búsqueda sistemática de literatura de las mejores evidencias disponibles en las bases de datos: MEDLINE/PubMed, LILACS, Cochrane y publicaciones institucionales de la Organización Mundial de la Salud y Organización Panamericana de la Salud. RESULTADOS Del total de estudios encontrados, se seleccionaron dos metanálisis que compararon las dos combinaciones. En ambas se evaluó el cumplimiento de la medicación, no se evaluó el control de presión arterial o efectos en los eventos cardiovasculares. Ambos estudios son de muy baja calidad de evidencia por sus limitaciones en la búsqueda, calidad subóptima de los estudios incluidos y lo heterogéneo de las variables analizadas. En las políticas de medicamentos de la Organización Mundial de la Salud no se sugiere el uso de antihipertensivos con combinaciones a dosis fijas. En Chile no están incluidos en el formulario nacional de medicamentos. CONCLUSIÓN Se requieren estudios bien diseñados para demostrar la efectividad de los medicamentos antihipertensivos en combinación a dosis fijas en comparación con combinaciones a dosis separadas para control de la presión arterial, la adherencia al tratamiento y disminución de la morbimortalidad cardiovascular.