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Key Factors in Hypertension

Key Factors in Hypertension

Hypertension is a well-known and treatable risk factor for heart attack and stroke, but research suggests that many hypertensive adults have poorly controlled blood pressure (BP). “Among those who know they have hypertension, many are not likely to have it under control,” says Uchechukwu Sampson, MD. “This is concerning, considering the progress that has been made with access, availability, and affordability of treatment options.” Studies suggest that lifestyle and socioeconomic status play a role in the prevalence of hypertension. “It’s important to evaluate factors associated with hypertension across races and ethnicities to understand the gravity of the problem,” Dr. Sampson says. With that in mind, he and his colleagues conducted a study—published in Circulation: Cardiovascular and Quality Outcomes—that looked at the prevalence and factors associated with hypertension. The analysis consisted of 69,211 participants from the Southern Community Cohort Study. Participants lived in the southeastern U.S., an area known for high rates of heart disease. Important Findings According to findings, the overall prevalence of self-reported hypertension was 57%, and more than half of blacks and nearly half of whites had uncontrolled BP. Participants who were extremely obese, defined as having a BMI higher than 40 kg/m2, were more likely to have high BP levels than others. “Black women were key drivers of the observed racial differences,” says Dr. Sampson. Similar findings were observed among those who did not report a history of hypertension. Nearly one-third of blacks and nearly one-quarter of whites had high BP but were unaware of it. “Among patients with self-reported and ascertained hypertension who indicated that they used an antihypertensive agent, only 44% were on two...

Managing Cognitive Decline in Older Adults With Diabetes

This Physician’s Weekly feature on managing cognitive decline in older adults with diabetes was completed in cooperation with the experts at the American Diabetes Association. More than 25% of Ameri­cans aged 65 and older has diabetes, and the aging of the overall population has been identified as a significant driver of the diabetes epidemic. “Diabetes in older adults is associated with higher mortality, reduced cogni­tive and functional status, and increased risk of institutionaliza­tion,” explains Hermes Florez, MD, PhD, MPH. “Importantly, diabetes has been linked to sig­nificantly higher risks of cogni­tive impairment, a greater rate of cognitive decline, and increased risk of dementia.” While various complications of diabetes are well known and well researched, the effect diabetes has on the brain has historically received relatively little attention. “The risk of both diabetes and cognitive impairment increases with age,” Dr. Florez says. “The presentation of cognitive impairment in people with diabetes can vary, ranging from subtle executive dysfunction to overt dementia and memory loss. We’re starting to see links between diabetes and dementia and Alzheimer’s disease, but researchers are still conducting analyses to further increase our knowledge on these associations.”  Consensus Report on Diabetes in Older Adults In the December 2012 issue of Diabetes Care, the American Diabetes Association released a consensus report on diabetes and older adults. Dr. Florez, who was on the writing group that developed the report, says that an important component to managing older adults with diabetes is the role of cognitive impairment. “For older patients with diabetes, treatments will need to be simplified whenever possible, and caregivers should be involved during consultations. The presence of cognitive...

Treating Hypertension: Opportunities Aplenty

Guidelines recommend that people with high blood pressure (BP) be prescribed medication and those on BP medications get a new one if their condition worsens or if BP control remains inadequate. It’s unclear how often these guidelines are followed on a national level. It’s likely that physicians are missing out on key opportunities to better control their patients’ high BP. Are Hypertension Guidelines Being Followed? In the September 24, 2012 Archives of Internal Medicine, my colleagues and I had a study published that analyzed new BP medication prescriptions for patients with uncontrolled hypertension. Using the National Ambulatory Medical Care Survey (NAMCS), we aimed to determine if physicians were following national recommendations and find out which factors influenced prescribing decisions. Data were reviewed on 16,473 visits between 2005 and 2009 for patients already diagnosed with high BP. Some patients were on BP medications, whereas others may have been told to bring their BP under control by other means, including lifestyle changes. “Empowering patients to discuss BP with their physicians may help us gain better control of the hypertension problem in the U.S.” According to our results, about 20% of the 7,153 visits by patients with uncontrolled hypertension— defined as 140/90 mm Hg and higher in the setting of a diagnosis of hypertension—resulted in new medications during doctors’ office visits. People with very high BP and those who specifically came to their doctor for hypertension were more likely to get a new prescription. Patients already on BP medications were less likely to get a new one. These factors remained highly significant in multivariable regression. Likelihood of New BP Medication Our findings...

Emerging Drug Options: High Blood Pressure

Hypertension affects approximately 70 million Americans and is a major risk factor for cardiovascular disease. It has been estimated that up to 65% of patients with hypertension do not have their blood pressure (BP) under control. Other studies have demonstrated that as many as 85% of hypertensive patients may need multiple medications to control their BP, underscoring the need for effective combination treatments. In 2009, the FDA approved aliskiren/valsartan (Valturna, Novartis) as a single-pill combination for the treatment of high BP in patients not adequately controlled on aliskiren or valsartan monotherapy. It was also approved as initial therapy in patients likely to need multiple drugs to achieve BP goals. Aliskiren/valsartan targets two key points within the renin-angiotensin aldosterone system (RAAS), which is believed to be an important regulator of BP. Valsartan blocks the action of angiotensin II, a component of the RAAS that causes blood vessels to tighten and narrow. Aliskiren directly inhibits renin, an enzyme that initiates the processes that lead to formation of angiotensin II. By targeting these two points within the RAAS, the agent helps blood vessels relax and widen so BP is lowered. Analyzing Clinical Trial Data A pivotal 8-week randomized, double-blind, placebo-controlled clinical trial involving about 1,800 patients helped lead to the FDA’s approval of aliskiren/valsartan. This trial analyzed use of aliskiren 150 mg and 300 mg and valsartan 160 mg and 320 mg alone and in combination. Initial doses of aliskiren and valsartan were 150 mg and 160 mg, respectively, and were increased at 4 weeks to 300 mg and 320 mg, respectively. BP reductions with the aliskiren/valsartan combination were significantly greater than...
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