Vital Signs: Disparities in #Antihypertensive Medication #Nonadherence Among Medicare Part D Beneficiaries — United States, 2014
https://www.cdc.gov/mmwr/volumes/65/wr/mm6536e1.htm?s_cid=mm6536e1_x
Conclusions More than one in four Medicare Part D beneficiaries using antihypertensives were nonadherent to their regimen, and certain racial/ethnic groups, states, and geographic areas were at increased risk for nonadherence. These findings can help inform focused interventions among these groups, which might improve blood pressure control and cardiovascular disease outcomes.
https://www.cdc.gov/mmwr/volumes/65/wr/mm6536e1.htm?s_cid=mm6536e1_x
Conclusions More than one in four Medicare Part D beneficiaries using antihypertensives were nonadherent to their regimen, and certain racial/ethnic groups, states, and geographic areas were at increased risk for nonadherence. These findings can help inform focused interventions among these groups, which might improve blood pressure control and cardiovascular disease outcomes.
www.cdc.gov
Vital Signs: Disparities in Antihypertensive Medication Nonadherence Among Medicare Part D Beneficiaries — United States, 2014…
The Morbidity and Mortality Weekly Report (MMWR) Series is prepared by the Centers for Disease Control and Prevention (CDC).
Monotherapy With Major #Antihypertensive Drug Classes and Risk of Hospital Admissions for #Mood Disorders
http://hyper.ahajournals.org/content/68/5/1132
Overall, our exploratory findings suggest possible differential effects of antihypertensive medications on mood that merits further study: calcium antagonists and β-blockers may be associated with increased risk, whereas angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be associated with a decreased risk of mood disorders
http://hyper.ahajournals.org/content/68/5/1132
Overall, our exploratory findings suggest possible differential effects of antihypertensive medications on mood that merits further study: calcium antagonists and β-blockers may be associated with increased risk, whereas angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be associated with a decreased risk of mood disorders
Hypertension
Monotherapy With Major Antihypertensive Drug Classes and Risk of Hospital Admissions for Mood DisordersNovelty and Significance
Major depressive and bipolar disorders predispose to atherosclerosis, and there is accruing data from animal model, epidemiological, and genomic studies that commonly used antihypertensive drugs may have a role in the pathogenesis or course of mood disorders.…
Association of 3 Different #Antihypertensive Medications With Hip and Pelvic #Fracture Risk in Older Adults
http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2587085
These findings from a large randomized clinical trial provide evidence of a beneficial effect of thiazide-type diuretic therapy in reducing hip and pelvic fracture risk compared with treatment with other antihypertensive medications.
http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2587085
These findings from a large randomized clinical trial provide evidence of a beneficial effect of thiazide-type diuretic therapy in reducing hip and pelvic fracture risk compared with treatment with other antihypertensive medications.
Jamanetwork
Hip and Pelvic Fracture Risk Associated With Antihypertensive Medications
This secondary analysis of a randomized clinical trial examines whether thiazide diuretics for hypertension are associated with reduced fracture risk in older adults.
#Antihypertensive Medication Postpones the Onset of #Glaucoma
http://hyper.ahajournals.org/content/early/2016/12/05/HYPERTENSIONAHA.116.08068
Therefore, although hypertension—as indicated by the use of antihypertensive medication—is positively correlated with glaucoma, our study indicates that antihypertensive medication itself may have a preventive effect on the development of glaucoma.
http://hyper.ahajournals.org/content/early/2016/12/05/HYPERTENSIONAHA.116.08068
Therefore, although hypertension—as indicated by the use of antihypertensive medication—is positively correlated with glaucoma, our study indicates that antihypertensive medication itself may have a preventive effect on the development of glaucoma.
Hypertension
Antihypertensive Medication Postpones the Onset of Glaucoma
The aim was to investigate the impact of antihypertensive medication on the onset of glaucoma. Data from the complete Danish population between 40 and 95 years of age were used in the period from 1996 to 2012, covering >2.6 million individuals. The National…
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Efficacy of self-monitored blood #pressure, with or without telemonitoring, for titration of #antihypertensive medication (TASMINH4): an unmasked randomised controlled trial
https://www.sciencedirect.com/science/article/pii/S014067361830309X
1182 participants were randomly assigned to the self-monitoring group (n=395), the telemonitoring group (n=393), or the usual care group (n=394), of whom 1003 (85%) were included in the primary analysis. After 12 months, systolic blood pressure was lower in both intervention groups compared with usual care (self-monitoring, 137·0 SD 16·7 mm Hg and telemonitoring, 136·0 16·1 mm Hg vs usual care, 140·4 16·5; adjusted mean differences vs usual care: self-monitoring alone, −3·5 mm Hg 95% CI −5·8 to −1·2; telemonitoring, −4·7 mm Hg –7·0 to −2·4). No difference between the self-monitoring and telemonitoring groups was recorded (adjusted mean difference −1·2 mm Hg 95% CI −3·5 to 1·2). Results were similar in sensitivity analyses including multiple imputation. Adverse events were similar between all three groups.
Interpretation
Self-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings. With most general practitioners and many patients using self-monitoring, it could become the cornerstone of hypertension management in primary care.
Efficacy of self-monitored blood #pressure, with or without telemonitoring, for titration of #antihypertensive medication (TASMINH4): an unmasked randomised controlled trial
https://www.sciencedirect.com/science/article/pii/S014067361830309X
1182 participants were randomly assigned to the self-monitoring group (n=395), the telemonitoring group (n=393), or the usual care group (n=394), of whom 1003 (85%) were included in the primary analysis. After 12 months, systolic blood pressure was lower in both intervention groups compared with usual care (self-monitoring, 137·0 SD 16·7 mm Hg and telemonitoring, 136·0 16·1 mm Hg vs usual care, 140·4 16·5; adjusted mean differences vs usual care: self-monitoring alone, −3·5 mm Hg 95% CI −5·8 to −1·2; telemonitoring, −4·7 mm Hg –7·0 to −2·4). No difference between the self-monitoring and telemonitoring groups was recorded (adjusted mean difference −1·2 mm Hg 95% CI −3·5 to 1·2). Results were similar in sensitivity analyses including multiple imputation. Adverse events were similar between all three groups.
Interpretation
Self-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings. With most general practitioners and many patients using self-monitoring, it could become the cornerstone of hypertension management in primary care.
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#Lifestyle Interventions Reduce the Need for Guideline-Directed #Antihypertensive Medication
https://www.abstractsonline.com/pp8/#!/4687/presentation/3369
..Nineteen had an estimated 10-year atherosclerotic cardiovascular disease risk ≥ 10% by the Pooled Cohort Equations, and 1 had diabetes. Blood pressure averaged 138±9/86±6 mmHg. Criteria for treatment with antihypertensive medications, as defined in the 2017 ACC-AHA Hypertension Guideline, were present in 53% (68 of 129). Blood pressure fell by 16/10 mmHg in DASH+WM, 11/8 mmHg in DASH, and 3/4 mmHg in UC. The percentage of subjects with indications for antihypertensive medical therapy fell from 54% (25 of 46) to 15% (7 of 46) in the DASH+WM group and from 51% (20 of 39) to 23% (9 of 39) in the DASH group; and did not significantly change (55% 24 of 44 to 48% 21 of 44) in the UC group (p = 0.001 for active treatments vs UC; p = 0.011 for DASH+WM vs DASH alone).
Conclusions: In overweight or obese men and women with hypertension, lifestyle interventions dramatically decrease the number of individuals for whom guideline-directed antihypertensive medication is indicated.
#Lifestyle Interventions Reduce the Need for Guideline-Directed #Antihypertensive Medication
https://www.abstractsonline.com/pp8/#!/4687/presentation/3369
..Nineteen had an estimated 10-year atherosclerotic cardiovascular disease risk ≥ 10% by the Pooled Cohort Equations, and 1 had diabetes. Blood pressure averaged 138±9/86±6 mmHg. Criteria for treatment with antihypertensive medications, as defined in the 2017 ACC-AHA Hypertension Guideline, were present in 53% (68 of 129). Blood pressure fell by 16/10 mmHg in DASH+WM, 11/8 mmHg in DASH, and 3/4 mmHg in UC. The percentage of subjects with indications for antihypertensive medical therapy fell from 54% (25 of 46) to 15% (7 of 46) in the DASH+WM group and from 51% (20 of 39) to 23% (9 of 39) in the DASH group; and did not significantly change (55% 24 of 44 to 48% 21 of 44) in the UC group (p = 0.001 for active treatments vs UC; p = 0.011 for DASH+WM vs DASH alone).
Conclusions: In overweight or obese men and women with hypertension, lifestyle interventions dramatically decrease the number of individuals for whom guideline-directed antihypertensive medication is indicated.
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The Relationship Between the Use of #Antihypertensive Drugs and the Incidence of #Dementia in General Practices in Germany
https://content.iospress.com/articles/journal-of-alzheimers-disease/jad190362
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.
The Relationship Between the Use of #Antihypertensive Drugs and the Incidence of #Dementia in General Practices in Germany
https://content.iospress.com/articles/journal-of-alzheimers-disease/jad190362
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.
Iospress
The Relationship Between the Use of Antihypertensive Drugs and the Incidence of Dementia in General Practices in Germany - IOS…
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 ant
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Clinical Outcomes After Intensifying #Antihypertensive Medication Regimens Among Older Adults at Hospital #Discharge
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2747871
Transient elevations of blood pressure (BP) are common in hospitalized older adults and frequently lead practitioners to prescribe more intensive antihypertensive regimens at hospital discharge than the patients were using before hospitalization
Within 30 days, patients receiving intensifications had a higher risk of readmission (hazard ratio [HR], 1.23; 95% CI, 1.07-1.42; number needed to harm [NNH], 27; 95% CI, 16-76) and serious adverse events (HR, 1.41; 95% CI, 1.06-1.88; NNH, 63; 95% CI, 34-370). At 1 year, no differences were found in cardiovascular events (HR, 1.18; 95% CI, 0.99-1.40) or change in systolic BP among those who did vs did not receive intensifications (mean BP, 134.7 vs 134.4; difference-in-differences estimate, 0.6 mm Hg; 95% CI, −2.4 to 3.7 mm Hg).
Conclusions and Relevance Among older adults hospitalized for noncardiac conditions, prescription of intensified antihypertensives at discharge was not associated with reduced cardiac events or improved BP control within 1 year but was associated with an increased risk of readmission and serious adverse events within 30 days.
Clinical Outcomes After Intensifying #Antihypertensive Medication Regimens Among Older Adults at Hospital #Discharge
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2747871
Transient elevations of blood pressure (BP) are common in hospitalized older adults and frequently lead practitioners to prescribe more intensive antihypertensive regimens at hospital discharge than the patients were using before hospitalization
Within 30 days, patients receiving intensifications had a higher risk of readmission (hazard ratio [HR], 1.23; 95% CI, 1.07-1.42; number needed to harm [NNH], 27; 95% CI, 16-76) and serious adverse events (HR, 1.41; 95% CI, 1.06-1.88; NNH, 63; 95% CI, 34-370). At 1 year, no differences were found in cardiovascular events (HR, 1.18; 95% CI, 0.99-1.40) or change in systolic BP among those who did vs did not receive intensifications (mean BP, 134.7 vs 134.4; difference-in-differences estimate, 0.6 mm Hg; 95% CI, −2.4 to 3.7 mm Hg).
Conclusions and Relevance Among older adults hospitalized for noncardiac conditions, prescription of intensified antihypertensives at discharge was not associated with reduced cardiac events or improved BP control within 1 year but was associated with an increased risk of readmission and serious adverse events within 30 days.
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Comprehensive comparative effectiveness and safety of first-line #antihypertensive drug classes: a systematic, multinational, large-scale analysis
..Most estimates revealed no effectiveness differences between classes; however, #thiazide or thiazide-like diuretics showed better primary effectiveness than angiotensin-converting enzyme inhibitors: acute myocardial infarction (HR 0·84, 95% CI 0·75–0·95), hospitalisation for heart failure (0·83, 0·74–0·95), and stroke (0·83, 0·74–0·95) risk while on initial treatment. Safety profiles also favoured thiazide or thiazide-like diuretics over angiotensin-converting enzyme inhibitors. The non-dihydropyridine calcium channel blockers were significantly inferior to the other four classes.
Interpretation
This comprehensive framework introduces a new way of doing observational health-care science at scale. The approach supports equivalence between drug classes for initiating monotherapy for hypertension—in keeping with current guidelines, with the exception of thiazide or thiazide-like diuretics superiority to angiotensin-converting enzyme inhibitors and the inferiority of non-dihydropyridine calcium channel blockers.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32317-7/fulltext
Comprehensive comparative effectiveness and safety of first-line #antihypertensive drug classes: a systematic, multinational, large-scale analysis
..Most estimates revealed no effectiveness differences between classes; however, #thiazide or thiazide-like diuretics showed better primary effectiveness than angiotensin-converting enzyme inhibitors: acute myocardial infarction (HR 0·84, 95% CI 0·75–0·95), hospitalisation for heart failure (0·83, 0·74–0·95), and stroke (0·83, 0·74–0·95) risk while on initial treatment. Safety profiles also favoured thiazide or thiazide-like diuretics over angiotensin-converting enzyme inhibitors. The non-dihydropyridine calcium channel blockers were significantly inferior to the other four classes.
Interpretation
This comprehensive framework introduces a new way of doing observational health-care science at scale. The approach supports equivalence between drug classes for initiating monotherapy for hypertension—in keeping with current guidelines, with the exception of thiazide or thiazide-like diuretics superiority to angiotensin-converting enzyme inhibitors and the inferiority of non-dihydropyridine calcium channel blockers.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32317-7/fulltext
#Antihypertensive medications and risk for incident #dementia and #Alzheimer's disease: a meta-analysis of individual participant data from prospective cohort studies
..We assessed the association of incident dementia and clinical Alzheimer's disease with use of five AHM classes, within strata of baseline high (systolic blood pressure [SBP] ≥140 mm Hg or diastolic blood pressure [DBP] ≥90 mm Hg) and normal (SBP <140 mm Hg and DBP <90 mm Hg) blood pressure.
..There were 3728 incident cases of dementia and 1741 incident Alzheimer's disease diagnoses. In the high blood pressure stratum (n=15 537), those using any AHM had a reduced risk for developing dementia (hazard ratio [HR] 0·88, 95% CI 0·79–0·98; p=0·019) and Alzheimer's disease (HR 0·84, 0·73–0·97; p=0·021) compared with those not using AHM. We did not find any significant differences between one drug class versus all others on risk of dementia. In the normal blood pressure stratum (n=15 553), there was no association between AHM use and incident dementia or Alzheimer's disease.
Interpretation
Over a long period of observation, no evidence was found that a specific AHM drug class was more effective than others in lowering risk of dementia. Among people with hypertensive levels of blood pressure, use of any AHM with efficacy to lower blood pressure might reduce the risk for dementia. These findings suggest future clinical guidelines for hypertension management should also consider the beneficial effect of AHM on the risk for dementia.
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(19)30393-X/fulltext
..We assessed the association of incident dementia and clinical Alzheimer's disease with use of five AHM classes, within strata of baseline high (systolic blood pressure [SBP] ≥140 mm Hg or diastolic blood pressure [DBP] ≥90 mm Hg) and normal (SBP <140 mm Hg and DBP <90 mm Hg) blood pressure.
..There were 3728 incident cases of dementia and 1741 incident Alzheimer's disease diagnoses. In the high blood pressure stratum (n=15 537), those using any AHM had a reduced risk for developing dementia (hazard ratio [HR] 0·88, 95% CI 0·79–0·98; p=0·019) and Alzheimer's disease (HR 0·84, 0·73–0·97; p=0·021) compared with those not using AHM. We did not find any significant differences between one drug class versus all others on risk of dementia. In the normal blood pressure stratum (n=15 553), there was no association between AHM use and incident dementia or Alzheimer's disease.
Interpretation
Over a long period of observation, no evidence was found that a specific AHM drug class was more effective than others in lowering risk of dementia. Among people with hypertensive levels of blood pressure, use of any AHM with efficacy to lower blood pressure might reduce the risk for dementia. These findings suggest future clinical guidelines for hypertension management should also consider the beneficial effect of AHM on the risk for dementia.
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(19)30393-X/fulltext
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#Lifestyle Changes in Relation to Initiation of #Antihypertensive and #Lipid‐Lowering Medication: A Cohort Study
Lifestyle modification is a key component of cardiovascular disease prevention before and concurrently with pharmacologic interventions..
..In participants who initiated medication use, body mass index increased more (difference in change 0.19; 95% CI, 0.16–0.22) and physical activity declined (−0.09 metabolic equivalent of task hour/day; 95% CI, −0.16 to −0.02) compared with noninitiators. The likelihood of becoming obese (odds ratio: 1.82; 95% CI, 1.63–2.03) and physically inactive (odds ratio: 1.08; 95% CI, 1.01–1.17) was higher in initiators. However, medication initiation was associated with greater decline in average alcohol consumption (−1.85 g/week; 95% CI, −3.67 to −0.14) and higher odds of quitting smoking (odds ratio for current smoking in the second survey: 0.74; 95% CI, 0.64–0.85).
Conclusions
These findings suggest that initiation of antihypertensive and statin medication is associated with lifestyle changes, some favorable and others unfavorable. Weight management and physical activity should be encouraged in individuals prescribed these medications.
https://bit.ly/2S3llel
#Lifestyle Changes in Relation to Initiation of #Antihypertensive and #Lipid‐Lowering Medication: A Cohort Study
Lifestyle modification is a key component of cardiovascular disease prevention before and concurrently with pharmacologic interventions..
..In participants who initiated medication use, body mass index increased more (difference in change 0.19; 95% CI, 0.16–0.22) and physical activity declined (−0.09 metabolic equivalent of task hour/day; 95% CI, −0.16 to −0.02) compared with noninitiators. The likelihood of becoming obese (odds ratio: 1.82; 95% CI, 1.63–2.03) and physically inactive (odds ratio: 1.08; 95% CI, 1.01–1.17) was higher in initiators. However, medication initiation was associated with greater decline in average alcohol consumption (−1.85 g/week; 95% CI, −3.67 to −0.14) and higher odds of quitting smoking (odds ratio for current smoking in the second survey: 0.74; 95% CI, 0.64–0.85).
Conclusions
These findings suggest that initiation of antihypertensive and statin medication is associated with lifestyle changes, some favorable and others unfavorable. Weight management and physical activity should be encouraged in individuals prescribed these medications.
https://bit.ly/2S3llel
www.ahajournals.org
Lifestyle Changes in Relation to Initiation of Antihypertensive and Lipid‐Lowering Medication: A Cohort Study | Journal of the…
Background Lifestyle modification is a key component of cardiovascular disease prevention before and concurrently with pharmacologic interventions. We evaluated whether lifestyle factors change in ...
#Antihypertensive medication needs and blood pressure control with weight loss in the #Diabetes Remission Clinical Trial (DiRECT)
https://2medical.news/2021/06/03/antihypertensive-medication-needs-and-blood-pressure-control-with-weight-loss-in-the-diabetes-remission-clinical-trial-direct/
https://2medical.news/2021/06/03/antihypertensive-medication-needs-and-blood-pressure-control-with-weight-loss-in-the-diabetes-remission-clinical-trial-direct/
2Medical.News
#Antihypertensive medication needs and blood pressure control with weight loss in the #Diabetes Remission Clinical Trial (DiRECT)
Our aim was to evaluate the safety and efficacy of a planned therapeutic withdrawal of all antihypertensive and diuretic medications, on commencing a formula low-energy diet replacement, targeting …