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Background: In recent years, there has been a growing interest in the association between the use of antihypertensive drugs and the incidence of dementia.Objective: The goal of this retrospective study was to investigate the relationship between antihypertensive drug use and dementia in elderly persons followed in general practices in Germany.Methods: This study included patients ≥60 years with documented blood pressure values who were diagnosed with dementia in general practices in Germany for the first time between 2013 and 2017 (index date). Dementia cases were matched to non-dementia controls using propensity scores based on age, sex, index year, and co-diagnoses. The main outcome of the study was the incidence of dementia as a function of the use of antihypertensive drugs.Results: The present study included 12,405 patients with dementia and 12,405 patients without dementia. The use of angiotensin II receptor blockers (odds ratios [ORs] ranging from 0.74 to 0.79), angiotensin-converting enzyme inhibitors (ORs ranging from 0.85 to 0.88), calcium channel blockers (ORs ranging from 0.82 to 0.89), and beta blockers (OR = 0.88) was associated with a decrease in dementia incidence.Conclusion: Antihypertensive drug use is negatively associated with dementia in elderly persons followed in general practices in Germany. [ABSTRACT FROM AUTHOR]

Purpose To validate two established questionnaires [Morisky and Medication Adherence Report Scale (MARS-5)] for the measurement of medical adherence of patients treated with antihypertensive drugs in primary care in Germany. Setting General practitioners (GPs) and their patients in North Rhine-Westphalia, Germany. Methods GPs were asked to recruit 12 consecutive patients using blood-pressure-lowering medication for at least 12 months. Patients were asked to fill out both the Morisky and MARS-5 questionnaires. The medication possession ratio (MPR) was calculated as reference standard for patients' medication adherence by using GPs' electronic patient records. The results of the questionnaires were then compared with the reference standard. Results A total of 14 GPs recruited 163 patients of which 128 were included in the analysis. Of the 128 patients, 52% were females; the age ranged from 44 to 96 years (mean 71). The overall adherence rate measured by the MPR was 62.1%. Compared to the reference standard, the Morisky Scale had a sensitivity of 31.9%, a specificity of 72.8% and a positive likelihood ratio (+LR) of 1.18. The MARS-5 had a sensitivity of 8.5%, a specificity of 97.4% and a +LR of 3.28. Conclusion The Morisky Scale and the MARS-5 cannot be recommended for measuring the adherence to antihypertensive drugs in a general practice setting in Germany at this point. These results emphasize the necessity to validate questionnaires in a specific setting before using them as instruments within a trial different from the original setting(s) of validation. [ABSTRACT FROM AUTHOR]

Aims: To assess whether blood pressure (BP) values below 140/90 mmHg during antihypertensive treatment are associated with a decreased risk of all-cause mortality in community-dwelling older adults., Methods and Results: Within the Berlin Initiative Study, we assembled a cohort of patients ≥70 years treated with antihypertensive drugs at baseline (November 2009-June 2011). End of prospective follow-up was December 2016. Cox proportional hazards models yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality associated with normalized BP [systolic BP (SBP) <140 mmHg and diastolic BP (DBP) <90 mmHg] compared with non-normalized BP (SBP ≥140 mmHg or DBP ≥90 mmHg) overall and after stratification by age or previous cardiovascular events. Among 1628 patients (mean age 81 years) on antihypertensive drugs, 636 exhibited normalized BP. During 8853 person-years of follow-up, 469 patients died. Compared with non-normalized BP, normalized BP was associated with an increased risk of all-cause mortality (incidence rates: 60.3 vs. 48.5 per 1000/year; HR 1.26; 95% CI 1.04-1.54). Increased risks were observed in patients ≥80 years (102.2 vs. 77.5 per 1000/year; HR 1.40; 95% CI 1.12-1.74) and with previous cardiovascular events (98.3 vs. 63.6 per 1000/year; HR 1.61; 95% CI 1.14-2.27) but not in patients aged 70-79 years (22.6 vs. 22.7 per 1000/year; HR 0.83; 95% CI 0.54-1.27) or without previous cardiovascular events (45.2 vs. 44.4 per 1000/year; HR 1.16, 95% CI 0.90-1.48)., Conclusion: Blood pressure values below 140/90 mmHg during antihypertensive treatment may be associated with an increased risk of mortality in octogenarians or elderly patients with previous cardiovascular events., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)

Background: Single-pill fixed dose combination (FDC) therapies are widely used in the treatment of arterial hypertension., Objective: This pilot study aimed to evaluate the effects of a FDC therapy combined with therapeutic drug monitoring (TDM) on blood pressure (BP) in patients with treatment resistant hypertension., Method: The study population included patients with suspected treatment-resistant hypertension during treatment with at least 3 antihypertensive drugs. We evaluated the effect of switching all patients to a regime including a single-pill triple FDC containing olmesartan, amlodipine and hydrochlorothiazide. Adherence was evaluated by measuring serum concentrations of amlodipine in a single-blinded fashion., Results: We enrolled 13 patients (mean age 57.2±9.1 years, 8 males) with resistant hypertension (office systolic and diastolic BP 158.3±17.3 and 94.8±11.1 mmHg); mean use of antihypertensive drugs was 3.8±1.1. Medication intake of FDC was confirmed in all patients at 18 weeks. Systolic and diastolic office BP were significantly lower (-22.8 and -13.6 mmHg) after 18 weeks of treatment with triple FDC (135.5±20.1 and 81.2±6.3 mmHg, p<0.01, respectively); mean use of antihypertensive drugs was 3.8±0.9. In 9 patients with 24-h ambulatory BP monitoring (ABPM) both at baseline and after 18 weeks, 24-h mean arterial pressure decreased (-9.3 mmHg, p=0.055). Overall, 9 (69%) patients achieved BP control in office BP and 4 (31%) in 24-h ABPM., Conclusion: Our results support the use of single-pill triple FDC therapy in combination with TDM for the management of patients with suspected treatment-resistant hypertension and further testing in clinical studies., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)