Prevalence of resistant hypertension in 1810 patients followed up in a specialized outpatient clinic and its association with the metabolic syndrome

Τζιόμαλος, Κωνσταντίνος; Kirkineska, L; Baltatzi, Maria; Efthymiou, Elias; Ψιάνου, Κωνσταντία; Papastergiou, Natalia; Magkou, Dimitra; Zervopoulos, Georgios; Kagelidis, Giannis; Karlafti, Eleni; Savopoulos, Christos; Hatzitolios, Apostolos

doi:10.3109/08037051.2013.765632

Cited by 7 publications

(9 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Moreover, several studies have shown that an increase in the number of antihypertensive agents is associated with reduced adherence to treatment . This observation is particularly pertinent for the management of hypertension, since most patients with hypertension require more than one agent to achieve BP targets …”

mentioning

confidence: 99%

Fixed‐dose combinations: A valuable tool to improve adherence to antihypertensive treatment

Satsoglou

Τζιόμαλος

2018

J of Clinical Hypertension

Self Cite

View full text Add to dashboard Cite

Hypertension is a major modifiable cardiovascular risk factor. [1][2][3] Several studies have shown that management of hypertension with all five main classes of blood pressure (BP)-lowering drugs (diuretics, β-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers) substantially reduces cardiovascular morbidity and mortality. 4 However, only a minority of patients with hypertension achieve BP targets. 5-7 An important contributor to these low rates of BP control is poor adherence to treatment. 8 Indeed, a substantial proportion of patients do not adhere to antihypertensive treatment. 8,9 In turn, poor adherence increases the risk for cardiovascular and all-cause mortality. 10,11 Several predictors of nonadherence to antihypertensive treatment have been identified, including older age, belonging to a racial/ethnic minority, male sex, and depression. 8,12 Moreover, several studies have shown that an increase in the number of antihypertensive agents is associated with reduced adherence to treatment. 8,12 This observation is particularly pertinent for the management of hypertension, since most patients with hypertension require more than one agent to achieve BP targets. 13,14 In this context, a meta-analysis by Du and colleagues 15 offers valuable information in the effort to improve adherence to antihypertensive treatment. The authors analyzed nine studies in 62 481 patients with hypertension and report that the mean difference of medication adherence for fixed-dose combination (FDC) vs freeequivalent combination therapies was 14.92% (95% confidence interval, 7.38%-22.46%). 15 Moreover, patients in the FDC group were nearly two times more likely to adhere to their antihypertensive treatment (risk ratio, 1.84, 95% confidence interval, 1.00-3.39). 15 Despite the important findings reported in this meta-analysis, there are still unanswered questions regarding the role of FDCs in the management of hypertension. First, eight of nine studies included in the meta-analysis by Du and coworkers 15 were retrospective. More prospective studies are needed to clearly define the benefits of FDCs. Moreover, this meta-analysis did not evaluate whether different types of FDCs (eg, renin-angiotensin system inhibitors combined with diuretics vs renin-angiotensin system inhibitors combined with calcium channel blockers) have the same impact on adherence. 15 It appears that adherence to diuretics is lower than with other antihypertensive agents. 12 On the other hand, calcium channel blocker use was reported to be independently associated with lower risk for decline in adherence. 16 This question has particular importance, since in the ACCOMPLISH (Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension) trial, combining an angiotensin-converting enzyme inhibitor with a calcium channel blocker reduced cardiovascular events more than the combination with a diuretic, despite a similar reduction in BP. 17 Third, only fixed combinations o...

show abstract

mentioning

confidence: 99%

Fixed‐dose combinations: A valuable tool to improve adherence to antihypertensive treatment

Satsoglou

Τζιόμαλος

2018

J of Clinical Hypertension

Self Cite

View full text Add to dashboard Cite

show abstract

“…Lessons from clinical trials repeatedly show that blood pressure control in hypertensive patients with concomitant metabolic syndrome especially with diabetes is exceedingly ineffective [14,15]. Interestingly, this phenomenon is difficult to address even nowadays, with implementation of modern e-health technologies [16,17].…”

Section: Metabolic Syndrome -A Hallmark Of Hypertensive Patientsmentioning

confidence: 99%

Hypertension management in the COVID-19 era. Getaway from pandemic snares

Wolf

2021

Arterial Hypertension

View full text Add to dashboard Cite

Hypertension prevalence and control prior to COVID-19 pandemic NCD Risk Factor Collaboration (NCD-RisC), a World Health Organization-endorsed initiative in collaboration with Imperial College London, has just recently issued an update on worldwide trends in hypertension prevalence, progress in treatment and control from 1990 to 2019 [1]. Data based on pooled analysis of 1201 population-representative studies with 104 million participants (representing 99% of global population) demonstrated that hypertension care varied substantially not only worldwide but also within neighboring regions. Although the main message of this report is rather gloomy, i.e., the number of people with hypertension has doubled to 1.28 billion since 1990, with 700 million people receiving no treatment, the authors also pointed at bright sides related to high blood pressure lowering strategies.In general, standardization of hypertension management seen over the last 30 years in upper-middle to newly-high-income countries demonstrated that introduction of modern universal healthcare, which includes novel pharmacotherapeutic formulas, effectively enhanced hypertension control with consequent reduction of hypertension-ascribed health burden [1].On the verge of the second decade of our millennium, controlled hypertension was estimated at the range of approximately 30% to 50% among

show abstract

“…13 In hypertension specialty clinics, where up-titration of antihypertensive medications occurs regularly and more severe cases are referred to, the prevalence of RH may range between 12 and 40 % (see Figure 1). 14,15 Among the 10,700 participants of the Reasons for Geographic and Racial Differences in Stroke study on treatment for hypertension, the prevalence of RH was double in the presence of an estimated glomerular filtration rate (GFR) lower than 45 ml/min/1.73 m2, in comparison to individuals with GFR greater than 60 ml/min/1.73 m2. 16 A recent systematic review and meta-analysis exploring the prevalence of RH in treated hypertensive populations included 20 observational studies and four randomised control trials (RCTs) with a total population of 961,035 individuals.…”

mentioning

confidence: 99%

Resistant Hypertension: A Real Entity Requiring Special Treatment?

Taddei

Bruno

2016

European Cardiology Review

View full text Add to dashboard Cite

Resistant hypertension (RH) was defined many years ago as a clinical situation in which blood pressure remains uncontrolled despite concomitant intake of at least three antihypertensive drugs (one of them preferably being a diuretic) at full doses. This operative definition was aimed at identifying a subset of hypertensive patients requiring a more extensive clinical workup in order to achieve an adequate blood pressure control. An oversimplification of this picture led to consider RH as a separate clinical entity requiring special, expensive treatments, such as renal denervation and baroreceptor activating therapy. In this review we will discuss the utility and the shortcomings of the definition of RH and the possible consequences for treatment.

show abstract

Prevalence of resistant hypertension in 1810 patients followed up in a specialized outpatient clinic and its association with the metabolic syndrome

Abstract: RH is frequent in patients followed up in hypertension outpatient clinics. In addition to age and obesity, MetS appears to be associated with increased risk for RH. Clarification of the mechanisms underpinning the association between MetS and hypertension might reduce the prevalence of RH.

Cited by 7 publications

References 24 publications

Fixed‐dose combinations: A valuable tool to improve adherence to antihypertensive treatment

Fixed‐dose combinations: A valuable tool to improve adherence to antihypertensive treatment

Hypertension management in the COVID-19 era. Getaway from pandemic snares

Resistant Hypertension: A Real Entity Requiring Special Treatment?

Contact Info

Product

Resources

About