The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: Part II – Therapy

Khan, Nadia; McAlister, Finlay A.; Rabkin, Simon W.; Padwal, Raj; Feldman, Ross D.; Campbell, Norman R.C.; Leiter, Lawrence A.; Lewanczuk, Richard; Schiffrin, Ernesto L.; Hill, Michael D; Arnold, Malcolm; Moe, Gordon W.; Campbell, Tavis S.; Herbert, Carol P.; Milot, Alain; Stone, James A.; Burgess, Ellen; Hemmelgarn, Brenda R.; Jones, Charlotte; Larochelle, Pierre; Ogilvie, Richard I.; Houlden, Robyn L.; Herman, Robert J.; Hamet, Pavel; Fodor, George; Carruthers, George; Culleton, Bruce F.; deChamplain, Jacques; Pylypchuk, George; Logan, Alexander G.; Gledhill, Norman; Petrella, Robert J.; Tobe, Sheldon W.; Touyz, Rhian M.

doi:10.1016/s0828-282x(06)70280-x

Cited by 146 publications

(148 citation statements)

References 29 publications

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“…3 The 1999 total cost of treating hypertension in the US was estimated to be $33.3 billion: 4 direct costs of medical care included $8.1 billion for drugs, $7.1 billion for hospital and nursing home care, $1.5 billion for home health care and other medical requirements, and $8.8 billion for lost productivity resulting from hypertension-related morbidity and mortality. 4 The 2004 Canadian recommendations for the management of hypertension, 5 the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, 2 and the International Society of Hypertension Guidelines for the Management of Hypertension 6 are examples of attempts to address the need for continued improvement in the management of hypertension. However, there is ample evidence for poor control of hypertension in many populations.…”

Section: Introductionmentioning

confidence: 99%

Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study

et al. 2005

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The objective was to assess persistence with antihypertensive therapy (AHT) and discontinuation patterns in patients newly dispensed different antihypertensive drug classes in a natural Canadian population-based setting. Hypertensive patients initiating AHT monotherapy were included in this 3-year retrospective cohort study (N ¼ 21 326) using the Saskatchewan health-care databases. Persistence was defined as consistently refilling a new prescription for AHT within 90 days of a previous dispensing. New courses of AHT were also documented in nonpersistent patients. Kaplan-Meier and Cox regression analyses were used to compare persistence and new courses of therapy across initial drugs. Compared to the newer angiotensin II antagonists (AIIAs), the likelihood of discontinuing therapy over the 39-month study period was significantly higher for angiotensin-converting enzymes inhibitors (HR ¼ 1.29; 95% CI ¼ 1.16-1.43), calcium channel blockers (HR ¼ 1.42; 95% CI ¼ 1.27-1.60), beta blockers (HR ¼ 1.62; 95% CI ¼ 1.45-1.80) and diuretics (HR ¼ 1.92; 95% CI ¼ 1.73-2.14). In the year following treatment discontinuation, between 54 and 75% of patients initiated a second course of treatment. Patients initiated on an AIIA had a significantly higher likelihood of starting a new course of therapy after a first treatment discontinuation, compared to all other agents. In conclusion, hypertensive patients initiated on an AIIA not only had greater persistence to AHT but were also more likely to initiate a new course of AHT after discontinuation than those initiating treatment with other agents. Further studies are required that relate intermittent treatment behaviours to health outcomes and costs in hypertension.

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Section: Introductionmentioning

confidence: 99%

Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study

et al. 2005

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“…[3][4][5] Whereas in the past, most hypertension guidelines focussed primarily on which drug was the best single agent, physicians are now encouraged to add a second (or third) drug rather than having monotherapy as an implicit goal in itself. [6][7][8] One way to encourage combination therapy and achieve goal BP in a higher percentage of patients is to have multiple agents available in one tablet. Combination therapy makes sense if there is a sound basis for including specific drugs in a single tablet.…”

Section: Introductionmentioning

confidence: 99%

The impact of one or two missed doses on the duration of action of combined perindopril and indapamide

Myers

Leenen

2006

J Hum Hypertens

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To evaluate the persistence of the antihypertensive effect of perindopril 4 mg þ indapamide 1.25 mg once daily for up to 72 h using the 'missed-dose' technique. Hypertensive patients were initially treated with perindopril 2 mg þ indapamide 0.625 mg once daily. After 4 weeks, the 135 of 216 patients who still had a diastolic BPX85 mm Hg went on to receive perindopril 4 mg þ indapamide 1.25 mg daily for a further 8 weeks. During either week 9 or 11, placebo was substituted for perindopril 4 mg þ indapamide 1.25 mg on either one or two consecutive days to simulate BP changes, which might occur after one or two missed doses. A 24-h ambulatory BP recording was performed at baseline, after 9 or 11 weeks of perindopril þ indapamide therapy and during the simulated missed doses, 24-48 and 48-72 h after the administration of perindopril 4 mg þ indapamide 1.25 mg. Significant (Po0.001) reductions in mean (7s.d.) 24-h ambulatory BP (mm Hg) during the first 24 h after perindopril 4 mg þ indapamide 1.25 mg therapy versus baseline were noted for patients later randomized to the one missed dose (À15.9710.5/ À9.477.6) or two missed dose (À17.478.7/À10.375.1) sub-groups. A significant reduction in BP (Po0.001 versus baseline) was still present on the days when placebo was substituted for perindopril 4 mg þ indapamide 1.25 mg with decreases in mean 24-h ambulatory BP from 24 to 48 h and 48 to 72 h after dosing being À11.9710.1/À6.976.2 and À10.679.9/À5.875.7, respectively. Use of the 'misseddose' technique has demonstrated a prolonged antihypertensive effect for perindopril 4 mg þ indapamide 1.25 mg for up to 72 h, supporting the use of this combination as therapy for hypertension.

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“…For assessment of risk factor control, targets for baseline serum measurements were less than 7.0 mmol/L for fasting serum glucose and less than 5.2 mmol/L for total serum cholesterol (6)(7)(8). Baseline BP targets were less than 140/90 mmHg for nondiabetic patients and less than 130/80 mmHg for diabetic patients (9). The Canadian Cardiovascular Society (CCS) criteria for the definition of the metabolic syndrome is based on the presence of three of the following: presence of abdominal obesity, elevated fasting glucose, elevated triglycerides, reduced highdensity lipoprotein (HDL) cholesterol and elevated BP (10).…”

Section: Méthodologiementioning

confidence: 99%

Management of atherothrombotic risk factors in high-risk Canadian outpatients

Bell

Hill

Herman

et al. 2009

Canadian Journal of Cardiology

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The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: Part II – Therapy

Cited by 146 publications

References 29 publications

Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study

Persistence and discontinuation patterns of antihypertensive therapy among newly treated patients: a population-based study

The impact of one or two missed doses on the duration of action of combined perindopril and indapamide

Management of atherothrombotic risk factors in high-risk Canadian outpatients

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