Assessment of Drug Therapy Management and the Prevalence of Heart Failure in a Managed Care Population With Hypertension

Jackson, James H.; Frech, Feride; Ronen, R; Mullany, Lawrence; Lennert, Barbara; Jhaveri, Vishu

doi:10.18553/jmcp.2004.10.6.513

Cited by 9 publications

(6 citation statements)

References 25 publications

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“…19 Data included medical and pharmacy claims as well as results from medical chart review. The study found that, among the subpopulation with DM (n=113), 30.1% had their BP controlled (<130/85 mm Hg) and approximately 47% were receiving ACE inhibitors or ARBs, compared with our findings of 27.6% with BP controlled (to < 130/80 mm Hg) and 51.3% on ACE inhibitors or ARBs or both.…”

Section: ■■ Discussionmentioning

confidence: 99%

Blood Pressure Goal Attainment According to JNC 7 Guidelines and Utilization of Antihypertensive Drug Therapy in MCO Patients With Type 1 or Type 2 Diabetes

Andros¹,

Egger²

2006

JMCP

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the year prior to the release of the JNC 7 definition of appropriate BP control.The treatment goal for individuals with HTN without other compelling conditions (i.e., diabetes mellitus [DM], heart failure, postmyocardial infarction (MI), chronic kidney disease, recurrent stroke prevention, or high coronary disease risk) is BP <140/90 mm Hg.1 JNC 7 guidelines set a goal of <140/90 mm Hg for the prevention and management of uncomplicated HTN to decrease morbidity and mortality by the least intrusive means possible.1 Although cardiovascular (CV) risk increases linearly with increases in systolic BP (SBP) >115 mm Hg, a more rapid increase in risk is noted when BP exceeds 140/90 mm Hg.2 In patients with HTN and DM or renal disease, the BP goal is <130/80 mm Hg. The American Diabetes Association (ADA) also recommends a BP goal <130/80 mm Hg for adults with DM. 3 Epidemiological analyses indicate that the attainment of this BP goal is associated with a decrease in CV rates and mortality in persons with DM without compromising safety or increasing the cost of care. can reduce complications such as nephropathy, cerebrovascular disease, and cardiovascular disease. As part of a quality improvement project with a managed care organization (MCO), we evaluated blood pressure (BP) control relative to the type of drug therapy for patients with type 1 or type 2 DM who were identified from pharmacy claims for antihyperglycemic drug therapy.METHODS: Pharmacy claims for antihyperglycemic drugs, including insulin, were used to identify a random sample of commercial members in an MCO comprising 30 health plans across the United States. Retrospective medical record review was conducted in October 2003 to collect data from 4,814 patient charts. BP goal attainment according to The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines was determined for each patient from the most recent BP reading documented in the medical chart. RESULTS:The distribution by type of DM was 21.0% (n = 1,011) for type 1, 75.7% (n = 3,644) for type 2, and 3.3% (n = 159) for cases not documented in the medical chart. Excluding 590 charts (12.3%) without BP values, there were 1,328 of 4,224 DM patients (31.4%) at JNC 7 BP goal (<130/80 mm Hg). Of the 1,328 patients at JNC 7 BP goal, 577 (43.4%) were at JNC 7 BP goal with no drug therapy. Excluding the 577 patients who did not require drug therapy to reach JNC 7 goal, 751 (20.6%) of the remaining 3,647 patients who required antihypertensive drug therapy were at JNC 7 BP goal, and 788 (21.6%) received no antihypertensive drug therapy. For the population of 4,224 DM patients with a BP value recorded in the chart, application of the lower BP goals in the JNC 7 guidelines reduced the proportion with controlled BP to 31.4% (1,328/4,224) from 42.6% (1,799/4,224) according to the former JNC 6 guidelines (P <0.01). The proportion of DM patients with HTN was 59.6% (n = 2,870), and 28.4% (n = 814) of these patients were not taking ei...

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Section: ■■ Discussionmentioning

confidence: 99%

Blood Pressure Goal Attainment According to JNC 7 Guidelines and Utilization of Antihypertensive Drug Therapy in MCO Patients With Type 1 or Type 2 Diabetes

Andros¹,

Egger²

2006

JMCP

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“…More than 850,000 people are hospitalized for arrhythmias each year and ventricular fibrillation (VF) is a leading cause of cardiac death[1]. Despite the intensive research in this area, the mechanism of VF is still poorly understood[2–5].…”

Section: Introductionmentioning

confidence: 99%

Patterned cardiomyocytes on microelectrode arrays as a functional, high information content drug screening platform

et al. 2011

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Cardiac side effects are one of the major causes of drug candidate failures in preclinical drug development or in clinical trials and are responsible for the retraction of several already marketed therapeutics. Thus, the development of a relatively high-throughput, high-information content tool to screen drugs and toxins would be important in the field of cardiac research and drug development. In this study, recordings from commercial multielectrode arrays were combined with surface patterning of cardiac myocyte monolayers to enhance the information content of the method; specifically, to enable the measurement of conduction velocity, refractory period after action potentials and to create a functional reentry model. Two drugs, 1-Heptanol, a gap junction blocker, and Sparfloxacin, a fluoroquinone antibiotic, were tested in this system. 1-Heptanol administration resulted in a marked reduction in conduction velocity, whereas Sparfloxacin caused rapid, irregular and unsynchronized activity, indicating fibrillation. As shown in these experiments, patterning of cardiac myocyte monolayers solved several inherent problems of multielectrode recordings, increased the temporal resolution of conduction velocity measurements, and made the synchronization of external stimulation with action potential propagation possible for refractory period measurements. This method could be further developed as a cardiac side effect screening platform after combination with human cardiomyocytes.

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“…Hypertension is a well‐established risk factor for development of HF, particularly in African American and elderly patients, and optimal BP control can decrease the risk of developing HF by approximately 50% 32 . RAAS inhibitors are appropriate initial therapy for patients with HF because they reduce morbidity, hospitalization rates, and mortality in all stages of the disease 7,32 . In addition, RAAS activation has been linked to the pathophysiology of HF, contributing to cardiac remodeling, fibrosis, sympathetic activation, and dilated cardiomyopathy 33 .…”

Section: Importance Of Bp Control In High‐risk Hypertensive Patients mentioning

confidence: 99%

“…32 RAAS inhibitors are appropriate initial therapy for patients with HF because they reduce morbidity, hospitalization rates, and mortality in all stages of the disease. 7,32 In addition, RAAS activation has been linked to the pathophysiology of HF, contributing to cardiac remodeling, fibrosis, sympathetic activation, and dilated cardiomyopathy. 33 In the Randomized Aldactone Evaluation Study (RALES), use of an aldosterone blocker (potassium-sparing diuretic) in addition to RAAS blockers reduced mortality in patients with moderate to severe HF.…”

Section: Heart Failurementioning

confidence: 99%

“…3 Uncontrolled BP (ie, !140 ⁄ 90 mm Hg) and high levels of total cardiovascularriskarecommonproblemsforhypertensive patients who have concomitant diseases such as diabetes, chronic kidney disease (CKD), and ⁄ or cardiovascular disease (CVD). [4][5][6][7] Factors that predispose patients to uncontrolled hypertension and cardiovascular and ⁄ or renal complications include heavy drinking, smoking, obesity, African American or Hispanic ethnicity, and history of stroke. 5,6,[8][9][10][11] In high-risk patients, intense cardiovascular risk reduction is necessary, including tight BP control.…”

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confidence: 99%

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Role of Single‐Pill Combination Therapy in Optimizing Blood Pressure Control in High‐Risk Hypertension Patients and Management of Treatment‐Related Adverse Events

Abdellatif

2012

J of Clinical Hypertension

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J Clin Hypertens (Greenwich). 2012;14:718–726. ©2012 Wiley Periodicals, Inc. Renin‐angiotensin‐aldosterone system (RAAS) inhibitors in combination with other antihypertensive drugs (eg, calcium channel blockers [CCBs] and/or diuretics) are a preferred treatment option for managing uncontrolled hypertension in high‐risk patients with chronic kidney disease (CKD), diabetes, or heart failure because RAAS inhibitors provide cardiorenal benefits in addition to lowering blood pressure (BP). However, when prescribing antihypertensive therapies to high‐risk patients, physicians must be aware of the risks of treatment‐related adverse events of hyperkalemia and peripheral edema associated with RAAS inhibitors and CCBs, respectively. This review discusses the use of single‐pill combination antihypertensive therapy to optimize BP control in high‐risk patients with CKD, diabetes, and/or heart failure and provides strategies for preventing and managing hyperkalemia and peripheral edema in this group. Single‐pill combination therapy can utilize different classes of antihypertensive drugs to reduce BP while mitigating the risks of treatment‐related adverse events, reducing pill burden, lowering medical cost, and improving patient compliance.

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Assessment of Drug Therapy Management and the Prevalence of Heart Failure in a Managed Care Population With Hypertension

Cited by 9 publications

References 25 publications

Blood Pressure Goal Attainment According to JNC 7 Guidelines and Utilization of Antihypertensive Drug Therapy in MCO Patients With Type 1 or Type 2 Diabetes

Blood Pressure Goal Attainment According to JNC 7 Guidelines and Utilization of Antihypertensive Drug Therapy in MCO Patients With Type 1 or Type 2 Diabetes

Patterned cardiomyocytes on microelectrode arrays as a functional, high information content drug screening platform

Role of Single‐Pill Combination Therapy in Optimizing Blood Pressure Control in High‐Risk Hypertension Patients and Management of Treatment‐Related Adverse Events

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