patterns of hypertension management in italy results of a pharmacoepidemiological survey on Antihypertensive Therapy

ObjectiveTo collect statistically significant information on patterns of Antihypertensive Therapy in medical practice, with particular attention to the drugs used in the pharmacological management of hypertensive patients and the reasons for the limited achievement of therapeutic goals during treatm

Antihypertensive Therapy: how to evaluate the benefits.

Abstract For more than 30 years, the benefits of Antihypertensive Therapy have been assessed in randomized trials that monitor cardiovascular events. Even greater benefits can result if prevention of (1) congestive heart failure, (2) left ventricular hypertrophy, and (3) progression to more severe hypertension is taken into consideration. However, quantifying the benefits in order to calculate the cost-effectiveness of treatment is not easy. Taking absolute risk and benefit as the only guide to treatment decisions may result in limiting Therapy only to elderly hypertensive patients and hypertensive patients with complications. Furthermore, randomized trials, of which the duration is necessarily short, are likely to underestimate treatment benefits. An alternative to such an approach is the actuarial approach: treatment benefits are calculated from the actuarial data showing the reduction in life expectancy associated with any given blood pressure increase. The cost of Antihypertensive Therapy per year of life gained calculated in this way is much lower than the cost calculated from randomized trials. In an uncertain area such as that of cost-effectiveness evaluation, it is important that both approaches are taken into consideration by physicians, patients, politicians, and officers of national health systems.

Short- and long-term perspectives of Antihypertensive Therapy. An introduction.

Randomized trials of Antihypertensive Therapy are relatively short in duration (3 to 5 years) and, when based on monitoring of the mortal and morbid events occurring during this period of time, represent short-term perspectives of Antihypertensive Therapy. In cases of mild-to-moderate hypertension, however, the goal of Antihypertensive Therapy is not the prevention of impending events but, rather, the avoidance or retardation of cardiovascular lesions. These long-term perspectives can only be explored by randomized trials that monitor surrogate endpoints (for example, left ventricular hypertrophy or atherosclerotic plaque development). In the future, more and more Antihypertensive drugs will be tested to assess their ability to interfere with both cardiovascular disease and cardiovascular events.

Antihypertensive Therapy in acute ischemic stroke: where do we stand?

Despite the proven benefits of strict blood pressure (BP) control on primary and secondary prevention of stroke, management of acute hypertensive response in the early post-stroke period is surrounded by substantial controversy. Observational studies showed that raised BP on ischemic stroke onset is prognostically associated with excess risk for early adverse events and mortality. By contrast, randomized controlled trials and recent meta-analyses showed that although Antihypertensive Therapy effectively controls elevated BP in the acute stage of ischemic stroke, this BP-lowering effect is not translated into improvement in the risk of death or dependency. On this basis, acute and aggressive BP responses within 24 h of stroke onset should be avoided and Antihypertensive Therapy is recommended only for patients presenting with acute ischemic stroke and BP > 220/120 mmHg or those with BP > 185/110 mmHg who are eligible for Therapy with intravenous tissue plasminogen activator. By contrast, recent clinical trials showed that intensive BP lowering to levels 

improved pregnancy outcome in type 1 diabetic women with microalbuminuria or diabetic nephropathy effect of intensified Antihypertensive Therapy

OBJECTIVE—To describe pregnancy outcome in type 1 diabetic women with normoalbuminuria, microalbuminuria, or diabetic nephropathy after implementation of an intensified Antihypertensive therapeutic strategy.

RESEARCH DESIGN AND METHODS—Prospective study of 117 pregnant women with type 1 diabetes. Antihypertensive Therapy, mainly methyldopa, was given to obtain blood pressure <135/85 mmHg and urinary albumin excretion <300 mg/24 h. Blood pressure and A1C were recorded during pregnancy. The pregnancy outcome was compared with recently published studies of pregnant women with microalbuminuria or diabetic nephropathy. RESULTS—Antihypertensive Therapy was given in 14 of 100 women with normoalbuminuria, 5 of 10 women with microalbuminuria, and all 7 women with diabetic nephropathy. Mean systolic blood pressure during pregnancy was 120 mmHg (range 101–147), 122 mmHg (116–135), and 135 mmHg (111–145) in women with normoalbuminuria, microalbuminuria, and diabetic nephropathy, respectively (P = 0.0095). No differences in mean diastolic blood pressure or A1C were detected between the groups. No women with microalbuminuria developed preeclampsia. The frequency of preterm delivery was 20% in women with normoalbuminuria and microalbuminuria in contrast to 71% in women with diabetic nephropathy (P < 0.01) where the median gestational age was 258 days (220–260). Compared with previous studies using less stringent Antihypertensive therapeutic strategy and less strict metabolic control, gestational age was longer and birth weight was larger in our study.

CONCLUSIONS—With intensified Antihypertensive Therapy and strict metabolic control, comparable pregnancy outcome was seen in type 1 diabetic women with microalbuminuria and normoalbuminuria. Although less severe than in previous studies, diabetic nephropathy was associated with more adverse pregnancy outcome.