British Hypertension Society guidelines for hypertension management 1999: summary

Few studies have investigated the presence of dyslipidaemia in hypertensive individuals. In addition, few data exist on the concurrent treatment of both conditions for the prevention of cardiovascular disease (CVD). This retrospective cohort study examined treatment patterns for hypertension and dyslipidaemia among hypertensive patients in UK primary care. We defined a population of patients aged X40 years from the UK General Practice Research Database. Hypertensive individuals with X3 additional cardiovascular risk factors (ARFs) were compared with a cohort comprising hypertensive patients with p2 ARFs. We analysed the prevalence of risk factors and the prevalence and incidence of treatment for hypertension, dyslipidaemia and for both conditions between January 1997 and December 2001. A total of 117 840 hypertensive patients were identified (23 655 with X3 ARFs, 94 185 with p2 ARFs) in 1997; in 2001, the number diagnosed as hypertensive was 133 683 (40 248 X3 ARFs, 93 435 p2 ARFs). The prevalence of antihypertensive treatment in the hypertensive patients with X3 ARFs increased during the study. In 2001, approximately one-third of hypertensive patients with X3 ARFs were not receiving antihypertensives. Among those patients who received such treatment, the majority received X2 separate agents in accordance with current guidelines. Treatment for concurrent hypertension and dyslipidaemia was initiated in o8% of patients with hypertension and X3 ARFs in each year. These findings demonstrate the under-recognition/undertreatment of cardiovascular risk factors in UK primary care among patients at risk of CVD.

show abstract

“…30 A sensitivity analysis was therefore also undertaken using these thresholds to define hypertension.…”

Section: Sensitivity Analysismentioning

confidence: 99%

Treatment patterns of hypertension and dyslipidaemia in hypertensive patients at higher and lower risk of cardiovascular disease in primary care in the United Kingdom

2007

View full text Add to dashboard Cite

show abstract

“…We need larger long-term comparative studies with agents producing similar hypotensive effect to extend such observations to hypertension in general. It may be argued that not all patients were on the maximum doses of ACE inhibitors, diuretics or calcium channel blockers, however the purpose of the study was to look at the effect of adding an ATII antagonist to patients already on therapy including an ACE inhibitor with resistant hypertension as this reflects more what is generally recommended 35 and is happening in clinical practice.…”

Section: Additive Effects Of Ace Inhibition and Angiotensin II Receptmentioning

confidence: 99%

Favourable effects on arterial wave reflection and pulse pressure amplification of adding angiotensin II receptor blockade in resistant hypertension

Mahmud

Feely

2000

J Hum Hypertens

View full text Add to dashboard Cite

Objective: Angiotensin-converting enzyme (ACE) inhibitors have beneficial effects on arterial compliance and distensibility and favourably modify the arterial pressure waveform in hypertensive patients. The objective of our study was to explore the possible effects of adding an ATII AT 1 receptor antagonist to an ACE inhibitor on augmentation pressure, a measure of arterial stiffness, and pulse pressure amplification in patients with poorly controlled essential hypertension. Design and methods: We studied a group of 18 patients with poorly controlled hypertension, despite at least three antihypertensive drugs including an ACE inhibitor, before, at 2 h and 2 weeks following the administration of 80 mg of valsartan, an ATII AT 1 receptor antagonist. Haemodynamic responses were measured by cuff sphygmomanometry, arterial pulse-wave analysis and the pulse pressure gradient was calculated as the difference between the brachial pulse pressure (cuff sphygmomanometry) and derived aortic pulse pressure (arterial pulse wave analysis). Results: Blood pressure decreased significantly (P Ͻ 0.001) and the effect was more pronounced on central

show abstract

“…The favourable efficacy profiles and affordability of thiazides make them a good choice from an economic perspective also. [35][36][37] Our earlier epidemiological studies showed that the major antihypertensive drug classes were also similar in their cumulative incidences of drug discontinuation and switching, 38,39 dyslipidemia, 40 hyponatremia, 41 hypokalemia 41 and hyperglycaemia. 42 This is compatible to recommendations from the findings of this study.…”

Section: Implications For Policy and Practicementioning

confidence: 99%

Profiles of mortality among Chinese hypertensive patients in Hong Kong: a cohort study

et al. 2009

View full text Add to dashboard Cite

We studied the profiles of all-cause and cardiovascular (CVS) mortality among users of different antihypertensive classes in a Chinese population. From electronic patient records, a cohort study was conducted among 18 338 patients who ever newly prescribed an a-blocker, thiazide diuretic, b-blocker, calcium channel blocker (CCB) or agents acting on the renin-angiotensin system (RAS) without drug discontinuation or switching in the public primary-care sector in a large Territory of Hong Kong during January 2004-June 2007. The odds ratios of mortality (all-cause and CVS) were evaluated according to the prescribed antihypertensive drug classes by Cox proportional hazards regression analyses. A total of 823 deaths (4.5%) were reported during the study period. The crude proportions of all-cause mortality were highest in a-blockers (6.2%) and CCB (5.7%), but lowest in b-blockers (2.8%). Compared with CCB, patients on thiazide diuretics were shown to have statistically significantly lower all-cause (adjusted hazard ratios (aHRs) 0.75, 95% CI 0.60, 0.93, P ¼ 0.010) and CVS mortality (aHR 0.40, 95% CI 0.21, 0.78, P ¼ 0.007), but the 95% CI of the odds ratios of the major drug classes overlapped. When each drug class was used as a reference group, or when patients with only uncomplicated hypertension were included, their respective 95% CI similarly overlapped. Antihypertensive drug classes were associated with statistically comparable odds of all-cause and CVS mortality. This finding from real-life clinical practice further supports the position statements from international guidelines, which recommend that the major antihypertensive drug classes are suitable for initiating pharmacotherapy for the management of hypertension.

show abstract

British Hypertension Society guidelines for hypertension management 1999: summary

Cited by 330 publications

References 26 publications

Treatment patterns of hypertension and dyslipidaemia in hypertensive patients at higher and lower risk of cardiovascular disease in primary care in the United Kingdom

Treatment patterns of hypertension and dyslipidaemia in hypertensive patients at higher and lower risk of cardiovascular disease in primary care in the United Kingdom

Favourable effects on arterial wave reflection and pulse pressure amplification of adding angiotensin II receptor blockade in resistant hypertension

Profiles of mortality among Chinese hypertensive patients in Hong Kong: a cohort study

Contact Info

Product

Resources

About