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Follow-up of Antihypertensive Therapy Improves Blood Pressure Control: Results of HYT (HYperTension survey) Follow-up

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Abstract

Introduction

Although improved during the past few years, blood pressure control remains sub optimal.

Aim

The impact of follow-up assessment on blood pressure control was evaluated in a group of patients of the HYT (HYperTension survey), treated with a combination of different dihydropyridine calcium-channel blockers (CCBs regimen) and inhibitors of renin-angiotensin-aldosterone system (RAAS) and with uncontrolled blood pressure. This was obtained assessing (a) the rate of blood pressure control at 3 and 6 months of follow-up in the whole group of patients, (b) the rate of blood pressure control and the average blood pressure values in subjects treated with different DHP-CCBs regimen.

Methods

From the 4993 patients with uncontrolled blood pressure, (BP ≥ 140/90 or ≥140/85 in patients with diabetes), 3729 (mean age 61.2 ± 11.5 years), maintained CCBs regimen combined wih RAAS blockers and were evaluated at 3 and 6 months follow-up. At each visit BP (semiautomatic device, Omron-M6, 3 measurements), heart rate, adverse events and treatment persistence were collected.

Results

At 1st and 2nd follow-up the rate of controlled BP was 63.5 and 72.8% respectively (p < 0.05 vs 35.3% at baseline), whereas in diabetes was 32.5 and 37.9% respectively (p < 0.05 vs 20% at baseline). No differences in heart rate were observed. No differences in control rate were observed between the different CCBs regimen. The incidence of drugs related adverse events was 3.6%.

Conclusions

These findings provide evidence that: (a) the follow-up of hypertensive patients under therapy increase the rate of blood pressure control; (b) there is no significant difference in the antihypertensive effect between different CCBs regimen; (c) lipophilic CCBs induce less ankle edema.

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References

  1. Borghi C, Tubach F, De Backer G, Dallongeville J, Guallar E, Medina J, Perk J, Roy C, Banegas JR, Rodriguez-Artalejo F, Halcox JP. Lack of control of hypertension in primary cardiovascular disease prevention in Europe: Results from the EURIKA study. Int J Cardiol. 2016;218:83–8.

    Article  PubMed  Google Scholar 

  2. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA. 2010;303:2043–50.

    Article  CAS  PubMed  Google Scholar 

  3. Tocci G, Nati G, Cricelli C, Parretti D, Lapi F, Ferrucci A, Borghi C, Volpe M. Prevalence and control of hypertension in different macro-areas in Italy: analysis of a large database by the general practice. High Blood Press Cardiovasc Prev. 2016;23:387–93.

    Article  PubMed  Google Scholar 

  4. Egan BM, Zhao Y, Axon N, et al. Uncontrolled apparent treatment resistant hypertension in United State, 1988 to 2008. Circulation. 2011;124:1046–58.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mancia G, Zambon A, Soranna D, Merlino L, Corrao G. Factors involved in the discontinuation of antihypertensive drug therapy: an analysis from real life data. J Hypertens. 2014;32:1708–15.

    Article  CAS  PubMed  Google Scholar 

  6. Okonofua EC, Simpson K, Jesri A, Rehman SU, Durkalski VL, Egan BM. Therapeutic inertia is an impediment to achieving the Healthy People 2010 blood pressure control goals. Hypertension. 2006;47:1–7.

    Article  Google Scholar 

  7. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, White A, Cushman WC, White W, Sica D, Ferdinand K, Giles TD, Falkner B, Carey RM. American Heart Association Professional Education Committee. Resistant hypertension: diagnosis, evaluation, and treatment: a Scientific Statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2008;51:1403–19.

    Article  CAS  PubMed  Google Scholar 

  8. Redon J, Mourad JJ, Schmieder RE, Volpe M, Weiss TW. Why in 2016 are patients with hypertension not 100% controlled? A call to action. J Hypertens. 2016;34:1480–8.

    Article  CAS  PubMed  Google Scholar 

  9. Brambilla G, Bombelli M, Seravalle G, Cifkova R, Laurent S, Narkiewicz K, Facchetti R, Redon J, Mancia G, Grassi G. Prevalence and clinical characteristics of patients with true resistant hypertension in central and Eastern Europe: data from the BP-CARE study. J Hypertens. 2013;31:2018–24.

    Article  CAS  PubMed  Google Scholar 

  10. Pepine CJ, Handberg EM, Cooper-DeHoff RM, Marks RG, Kowey P, Messerli FH, Mancia G, Cangiano JL, Garcia-Barreto D, Keltai M, Erdine S, Bristol HA, Kolb HR, Bakris GL, Cohen JD. Parmley WW; INVEST Investigators. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA. 2003;290:2805–16.

    Article  CAS  PubMed  Google Scholar 

  11. Kjeldsen SE, Sica D, Haller H, Cha G, Gil-Extremera B, Harvey P, Heyvaert F, Lewin AJ, Villa G, Mancia G, For the DISTINCT Investigators. Nifedipine plus candesartan combination increases blood pressure control regardless of race and improves the side effect profile: DISTINCT randomized trial results. J Hypertens. 2014;32:2488–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Jamerson K, Weber A, Bakris GL, Dahlöf B, Pitt B, Shi V, Hester A, Gupte J, Gatlin M, Velazquez EJ, ACCOMPLISH Trial Investigators. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high risk patients. N Engl J Med. 2008;359:2417–28.

    Article  CAS  PubMed  Google Scholar 

  13. Punzi H, Neutel JM, Kereiakes DJ, Shojaee A, Waverczak WF, Dubiel R, Maa JF. Efficacy of amlodipine and olmesartan medoxomil in patients with hypertension: the AZOR Trial Evaluating Blood Pressure Reductions and Control (AZTEC) study. Ther Adv Cardiovasc Dis. 2010;4:209–21.

    Article  CAS  PubMed  Google Scholar 

  14. Chrysant SG, Oparil S, Melino M, Karki S, Lee J, Heyrman R. Efficacy and safety of long-term treatment with the combination of amlodipine besylate and olmesartan medoxomil in patients with hypertension. J Clin Hypertens. 2009;11:475–82.

    Article  CAS  Google Scholar 

  15. Seravalle G, Koylan N, Nalbantgil I, Caglar N, Quarti-Trevano F, Makel W, Grassi G, Fici F. HYT-Hypertension in Turkey: a cross-sectional survey on blood pressure control with calcium channel blockers alone or combined with other antihypertensive drugs. High Blood Press Cardiovasc Prev. 2015;22:165–72.

    Article  CAS  PubMed  Google Scholar 

  16. Grassi G, Cifkova R, Laurent S, Narkiewicz K, Redon J, Farsang C, Viigimaa M, Erdine S, Brambilla G, Bombelli M, Dell’Oro R, Notari M, Mancia G. Blood pressure control and cardiovascular risk profile in hypertensive patients from central and eastern European countries: results of BP-Care study. Eur Heart J. 2011;32:218–35.

    Article  PubMed  Google Scholar 

  17. Banegas JR, Esther Lopez-Garcıa E, Dallongeville J, Guallar E, Halcox JP, Borghi C, Massó-González EL, Jiménez FJ, Perk J, Steg PG, De Backer G, Rodríguez-Artalejo F. Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: the EURIKA study. Eur Heart J. 2011;32:2143–52.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Reiner Z, Keil U, EUROASPIRE Study Group. EUROASPIRE III. Management of cardiovascular risk factors in asymptomatic high-risk patients in general practice: cross-sectional survey in 12 European countries. Eur J Cardiovasc Prev Rehab. 2010;17:530–40.

    Article  Google Scholar 

  19. Giannattasio C, Cairo M, Cesana F, Alloni M, Sormani P, Colombo G, Grassi G, Mancia G. Blood pressure control in Italian essential hypertensives treated by general practitioners. Am J Hypertens. 2012;25:1182–7.

    Article  PubMed  Google Scholar 

  20. Carrington MJ, Jennings BPGL, Stewart S. Pressure points in primary care: blood pressure and management of hypertension in 532 050 patients from 2005 to 2010. J Hypertens. 2013;31:1265–71.

    Article  CAS  PubMed  Google Scholar 

  21. Friedberg JP, Rodriguez MA, Watsula ME, Lin I, Wylie-Rosett J, Allegrante JP, Lipsitz SR, Natarajan S. Effectiveness of a tailored behavioral intervention to improve hypertension control: primary outcomes of a randomized controlled trial. Hypertension. 2015;65:440–6.

    Article  CAS  PubMed  Google Scholar 

  22. Glynn LG, Murphy AW, Smith SM, Schroeder K, Faey T. Interventions to used improve control of blood pressure in patients with hypertension. Cochrane Database Syst Rev. 2010;. doi:10.1002/14651858.CD005182.

    PubMed  Google Scholar 

  23. Dahlöf B, Sever PS, Poulter NR, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005;366:895–906.

    Article  PubMed  Google Scholar 

  24. Mallion JM, Genès N, Vaur L, Clerson P, Vaïsse B, Bobrie G. Blood pressure levels, risk factors and antihypertensive treatments: lessons from the SHEAF study. J Hum Hypertens. 2001;15:841–8.

    Article  CAS  PubMed  Google Scholar 

  25. Hanninen JA, Takala JM, Keinanen-Kiukaanniemi SM. Blood pressure control in subjects with type 2 diabetes. J Human Hypert. 2000;14:111–5.

    Article  CAS  Google Scholar 

  26. World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: WHO; 2003.

    Google Scholar 

  27. Hirakawa Y, Arima H, Webster R, Zoungas S, Li Q, Harrap S, Lisheng L, Hamet P, Mancia G, Poulter N, Neal B, Williams B, Rogers A, Woodward M, Chalmers J. Risks associated with permanent discontinuation of blood pressure-lowering medications in patients with type 2 diabetes. J Hypertens. 2016;34:781–7.

    Article  CAS  PubMed  Google Scholar 

  28. Villevalde S, Kobalava Z. LBOS 01-06 Integrated approach improved blood pressure control in non-adherent motivated hypertensive patients: Prisma study. J Hypertens. 2016;34(suppl 1):e548.

    Article  Google Scholar 

  29. Hosie J, Wiklund I. Managing hypertension in general practice: can we do better? J Hum Hypertens. 1995;9(suppl 2):S15–8.

    PubMed  Google Scholar 

  30. National Institute for Health and Clinical Excellence. Hypertension. Clinical management of primary hypertension in adults.National Clinical Guideline Centre. London: Royal College of Physicians (UK). 2011. http://www.guidance.nice.org.uk/CG127.

  31. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC Jr, Svetkey LP, Taler SJ, Townsend RR, Wright JT Jr, Narva AS, Ortiz E. Evidence-based guideline for the management of high blood pressure in adults. Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507–20.

    Article  CAS  PubMed  Google Scholar 

  32. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F. ESH/ESC Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood Press. 2013;22:193–278.

    Article  Google Scholar 

  33. Mancia G, Kjeldsen SE, Zappe DH. Cardiovascular outcomes at different on-treatment blood pressures in the hypertensive patients of the VALUE trial. Eur Heart J. 2016;37:955–64.

    Article  PubMed  Google Scholar 

  34. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 4. Effects of various classes of antihypertensive drugs. Overview and meta-analyses. J Hypertens. 2015;33:195–211.

    Article  CAS  PubMed  Google Scholar 

  35. Costanzo P, Perrone-Filardi P, Petretta M, Marciano C, Vassallo E, Gargiulo P, Paolillo S, Petretta A, Chiariello M. Calcium channel blockers and cardiovascular outcomes: a meta-analysis of 175,634 patients. J Hypertens. 2009;27:1136–51.

    Article  CAS  PubMed  Google Scholar 

  36. Bangalore S, Parkar S, Messerli FH. Long-Acting calcium antagonists in patients with coronary artery disease: a meta-analysis. Am J Med. 2009;122:356–65.

    Article  CAS  PubMed  Google Scholar 

  37. Wu L, Deng SB, She Q. Calcium channel blocker compared with angiotensin receptor blocker for patients with hypertension: a meta-analysis of randomized controlled trials. J Clin Hypertens. 2014;16:838–45.

    Article  Google Scholar 

  38. Verdecchia P, Reboldi G, Angeli F, Gattobigio R, Bentivoglio M, Thijs L, Staessen JA, Porcellati C. Angiotensin-converting enzyme inhibitors and calcium channel blockers for coronary heart disease and stroke prevention. Hypertension. 2005;46:386–92.

    Article  CAS  PubMed  Google Scholar 

  39. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 2. Effects at different baseline and achieved blood pressure levels overview and meta-analyses of randomized trials. J Hypertens. 2014;32:2296–304.

    Article  CAS  PubMed  Google Scholar 

  40. Makani H, Bangalore S, Romero J, Wever-Pinzon O, Messerli FH. Effect of renin-angiotensin system blockade on calcium channel blocker-associated peripheral edema. Am J Med. 2011;124:128–35.

    Article  CAS  PubMed  Google Scholar 

  41. Weir MR. Incidence of pedal edema formation with dihydropyridine calcium channel blockers: issues and practical significance. J Clin Hypertens. 2003;5:330–5.

    Article  CAS  Google Scholar 

  42. Sica DA. Calcium channel blocker-related periperal edema: can it be resolved? J Clin Hypertens. 2003;5:291–4.

    Article  Google Scholar 

  43. Messerli F. Vasodilatory edema: a common side effect of antihypertensive therapy. Am J Hypertens. 2001;14:978–9.

    Article  CAS  PubMed  Google Scholar 

  44. Lund-Johansen P, Stranden E, Helberg S, Wessel-Aas T, Risberg K, Rønnevik PK, Istad H, Madsbu S. Quantification of leg oedema in postmenopausal hypertensive patients treated with lercanidipine or amlodipine. J Hypertens. 2003;21:1003–10.

    Article  CAS  PubMed  Google Scholar 

  45. Fogari R, Malamani GD, Zoppi A, Preti P, Vanasia A, Fogari E, Mugellini A. Comparative effect of lercanidipine and nifedipine gastrointestinal therapeutic system on ankle volume and subcutaneous interstitial pressure in hypertensive patients: a double-blind, randomized, parallel-group study. Curr Ther Res. 2000;61:850–62.

    Article  CAS  Google Scholar 

  46. Pedrinelli R, Dell’Omo G, Nuti M, Menegato A, Balbarini A, Mariani M. Heterogeneous effect of calcium antagonists on leg oedema: a comparison of amlodipine versus lercanidipine in hypertensive patients. J Hypertens. 2003;21:1969–73.

    Article  CAS  PubMed  Google Scholar 

  47. Barrios V, Navarro A, Esteras A, Luque M, Romero J, Tamargo J, Prieto L, Carrasco JL, Herranz I, Navarro-Cid J, Ruilope LM, Investigators of ELYPSE Study (Eficacia de Lercanidipino y su Perfil de Seguridad). Antihypertensive efficacy and tolerability of lercanidipine in daily clinical practice. The ELYPSE study. Eficacia de Lercanidipino y su Perfil de Seguridad. Blood Press. 2002;11:95–100.

    Article  CAS  PubMed  Google Scholar 

  48. Burnier M, Gasser UE. Efficacy and tolerability of lercanidipine in patients with hypertension: results of a phase IV study in general practice. Expert Opin Pharmacother. 2007;8:2215–23.

    Article  CAS  PubMed  Google Scholar 

  49. Borghi C, Prandin MG, Dormi A, Ambrosioni E, Study Group of the Regional Unit of the Italian Society of Hypertension. Improved tolerability of the dihydropyridine calcium-channel antagonist lercanidipine: the lercanidipine challenge trial. Blood Press. 2003;12(suppl 1):14–21.

    Article  Google Scholar 

  50. Makarounas-Kirchmann K, Glover-Koudounas S, Ferrari P. Results of a meta-analysis comparing the tolerability of lercanidipine with the 1st and 2nd generation dihydropyridine calcium channel blockers. Clin Ther. 2009;31:1652–63.

    Article  CAS  PubMed  Google Scholar 

  51. Bangalore S, Fakheri R, Toklu B, Ogedegbe G, Weintraub H, Messerli FH. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in patients without heart failure? Insights from 254301 patients from randomized trials. Mayo Clin Proc. 2016;91:51–60.

    Article  CAS  PubMed  Google Scholar 

  52. Matchar DB, McCrory DC, Orlando LA, Patel MR, Patel UD, Patwardhan MB, Powers B, Samsa GP, Gray RN. Systematic review: comparative effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treating essential hypertension. Ann Intern Med. 2008;148:16–29.

    Article  PubMed  Google Scholar 

  53. Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, Schumacher H, Dagenais G, Sleight P, Anderson C. Telmisartan, ramipril, or both in patients at high risk for vascular events. ONTARGET Investigators. N Engl J Med. 2008;358:1547–59.

    Article  CAS  PubMed  Google Scholar 

  54. Li EC, Heran BS, Wright JM. Angiotensin converting enzyme (ACE) inhibitors versus angiotensin receptor blockers for primary hypertension. Cochrane Database Syst Rev. 2014;. doi:10.1002/14651858.CD009096 (24 Aug 2014).

    Google Scholar 

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Authors and Affiliations

  1. Clinica Medica, Università Milano Bicocca, via Pergolesi 33, Monza-Milan, 20052, Italy

    F. Fici, F. Quarti-Trevano & G. Grassi

  2. Cardiology Department, Istituto Auxologico Italiano, IRCCS S. Luca Hpt, Milan, Italy

    G. Seravalle

  3. Anadolu Saglik Merkezi, Istanbul, Turkey

    N. Koylan

  4. Department of Cardiology, Ege University, Izmir, Turkey

    I. Nalbantgil

  5. Düzen Labaratuvarları, Ankara, Turkey

    N. Cagla

  6. Primary Care Department, Dumlupinar University, Kutahyta, Turkey

    Y. Korkut

  7. Clinical Research Facilities International B.V., Schaijk, The Netherlands

    W. Makel

  8. IRCCS Multimedica, Sesto San Giovanni, Milan, Italy

    G. Grassi

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  1. F. Fici
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Correspondence to G. Grassi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki declaration and its later amendments.

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Fici, F., Seravalle, G., Koylan, N. et al. Follow-up of Antihypertensive Therapy Improves Blood Pressure Control: Results of HYT (HYperTension survey) Follow-up. High Blood Press Cardiovasc Prev 24, 289–296 (2017). https://doi.org/10.1007/s40292-017-0208-1

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