Underuse of antihypertensive therapies in at-risk populations
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Effective control of elevated blood pressure (BP) levels over the long term substantially lowers the likelihood of premature mortality, microvascular and macrovascular diseases, and pressure-sensitive organ failure (eg, heart failure). High-risk hypertensive patients, such as those with concomitant cardiovascular-renal conditions (eg, diabetes, dyslipidemia), vascular disease, depressed heart/kidney function, or even just severe BP elevations, are at high risk for pressure-sensitive complications. African Americans are another high-risk demographic group but, arguably, because diet and lifestyle attributes lead to high levels of cardiovascular-renal conditions. Although high-risk hypertensive patients accrue the largest absolute risk reductions when treated effectively, they are least likely to attain goal BP levels below recommended targets. This is significantly attributable to resistance to antihypertensive treatment. Undertreatment of high-risk hypertensive patients occurs because of factors related to the patient, physician, the patient-physician interface, and the system (or typically lack thereof) of care delivery.
- Chobanian AV, Bakris GL, Black HR, et al.: Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003, 42:1206–1252. CrossRef
- Vasan RS, Larson MG, Leip EP, et al.: Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001, 345:1291–1297. CrossRef
- Flack JM, Neaton JA, Grimm R Jr, et al.: Blood pressure and mortality among men with prior myocardial infarction. Multiple Risk Factor Intervention Trial Research Group. Circulation 1995, 92:2437–2445.
- Franklin SS, Larson MG, Khan SA, et al.: Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation 2001, 103:1245–1249.
- Sowers JR, Haffner S: Treatment of cardiovascular and renal risk factors in the diabetic hypertensive. Hypertension 2002, 40:781–788. CrossRef
- Schrier RW, Estacio RO, Esler A, Mehler P: Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy, and strokes. Kidney Int 2002, 61:1086–1097. CrossRef
- Duncan K, Ramappa P, Thornburg R, et al.: The influence of urinary albumin excretion and estimated glomerular filtration rate on blood pressure response in drug-treated hypertensive patients in an academic hypertension clinic [abstract]. Am J Hypertens 2001, 14(4 Suppl 1):A196. CrossRef
- Bakris GL: Microalbuminuria: what is it? Why is it important? What should be done about it? J Clin Hypertens (Greenwich) 2001, 3:99–102. CrossRef
- Folsom AR, Szklo M, Stevens J, et al.: A prospective study of coronary heart disease in relation to fasting insulin, glucose, and diabetes. The Atherosclerosis Risk in Communities (ARIC) Study. Diabetes Care 1997, 20:935–942. CrossRef
- Bakris GL: Maximizing cardiorenal benefit in the management of hypertension: achieve blood pressure goals. J Clin Hypertens 1999, 1:141–147.
- Flack JM, Peters R, Shafi T, et al.: Prevention of hypertension and its complications: theoretical basis and guidelines for treatment. J Am Soc Nephrol 2003, 14(7 Suppl 2):S92–S98. CrossRef
- Wong ND, Lopez VA, L’Italien G, et al.: Inadequate control of hypertension in US adults with cardiovascular disease comorbidities in 2003–2004. Arch Intern Med 2007, 167:2431–2436. CrossRef
- Lloyd-Jones DM, Evans JC, Larson MG, et al.: Differential control of systolic and diastolic blood pressure: factors associated with lack of blood pressure control in the community. Hypertension 2000, 36:594–599.
- Curb JD, Pressel SL, Cutler JA, et al.: Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension: Systolic Hypertension in the Elderly Program Cooperative Research Group. JAMA 1996, 276:1886–1892. CrossRef
- National Center for Health Statistics: Fastasts. Available at http://www.cdc.gov/nchs/fastats/. Accessed March 24, 2008.
- Cushman WC, Ford CE, Cutler JA, et al.: Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid lowering treatment to prevent heart attack trial (ALLHAT). J Clin Hypertens 2002, 4:393–404. CrossRef
- Hicks LS, Fairchild DG, Horng MS, et al.: Determinants of JNC VI guideline adherence, intensity of drug therapy, and blood pressure control by race and ethnicity. Hypertension 2004, 44:429–434. CrossRef
- Tykarski A: Resistant hypertension. Blood Press 2005, 14(Suppl 2):42–45. CrossRef
- Ashley FW Jr, Kannel WB: Relation of weight change to changes in atherogenic traits: the Framingham Study. J Chronic Dis 1974, 27:103–114. CrossRef
- Wright JT Jr, Dunn JK, Cutler JA, et al.: Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. JAMA 2005, 293:1595–1608. CrossRef
- Cushman WC, Reda DJ, Perry HM, et al.: Regional and racial differences in response to antihypertensive medication use in a randomized controlled trial of men with hypertension in the United States. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. Arch Intern Med 2000, 160:825–831. CrossRef
- Peralta CA, Hicks LS, Chertow GM, et al.: Control of hypertension in adults with chronic kidney disease in the United States. Hypertension 2005, 45:1119–1124. CrossRef
- Dell’Omo G, Penno G, Giorgi D, et al.: Association between high-normal albuminuria and risk factors for cardiovascular and renal disease in essential hypertensive men. Am J Kidney Dis 2002, 40:1–8. CrossRef
- Flack JM, Duncan K, Ohmit SE, et al.: Influence of albuminuria and glomerular filtration rate on blood pressure response to antihypertensive drug therapy. Vasc Health Risk Manag 2007, 3:1029–1037.
- Mattix HJ, Hsu C, Shaykevich S, Curhan G: Use of the albumin/creatinine ratio to detect microalbuminuria: implications of sex and race. J Am Soc Nephrol 2002, 13:1034–1039.
- Jamerson K, DeQuattro V: The impact of ethnicity on response to antihypertensive therapy. Am J Med 1996, 101:22S–32S. CrossRef
- American Heart Association: 2002 Heart and Stroke Statistical Update. Dallas: American Heart Association; 2001.
- White H, Boden-Albala B, Wang C, et al.: Ischemic stroke subtype incidence among whites, blacks, and Hispanics: the Northern Manhattan Study. Circulation 2005, 111:1327–1331. CrossRef
- US Renal Data System: USRDS 2001 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2001.
- Saydah SH, Fradkin J, Cowie CC: Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA 2004, 291:335–342. CrossRef
- Douglas JG, Bakris GL, Epstein M, et al.: Management of high blood pressure in African Americans: consensus statement of the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks. Arch Intern Med 2003, 163:525–541. CrossRef
- Rosendorff C, Black HR, Cannon CP, et al.: Treatment of hypertension in the prevention and management of ischemic heart disease: a scientific statement from the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention. Circulation 2007, 115:2761–2788. CrossRef
- Underuse of antihypertensive therapies in at-risk populations
Current Cardiovascular Risk Reports
Volume 2, Issue 3 , pp 192-197
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