Sexual sequelae of antihypertensive drugs: Treatment effects on self-report and physiological measures in middle-aged male hypertensives

Antihypertensive drugs are commonly associated with adverse side effects in both clinical and laboratory studies. We investigated the sexual sequelae of several major classes of antihypertensive drugs (e.g., beta blockers, central alpha agonists, diuretics) in normal males and in hypertensive patients. We compared the effects of four widely used agents (methyldopa, propranolol, atenolol, hydrochlorothiazide-triamterene) and placebo, in a selected sample of 21 sexually dysfunctional male hypertensives, 13 of whom completed all five phases of the study. Each study drug was administered for a 1-month treatment period, followed by a 2-week, single-blind washout phase, according to a randomized, Latin square crossover design. Dependent variables for the study included a broad range of hormonal, NPT, and self-report measures of sexual response. Results indicated a lack of consistent drug effects on measures of sexual response, although more frequent sexual and nonsexual side effects were observed with methyldopa and propranolol. As in our previous studies, age was negatively correlated with both hormonal and NPT measures, whereas changes in blood pressure were not significantly related to sexual function scores. Results do not support the hypothesis that sexually dysfunctional males are at greater risk for adverse sexual sequelae when treated with centrally active agents or diuretics.     

Higher persistence with valsartan compared with enalapril in daily practice

Objective

To compare persistence with valsartan and enalapril in daily practice.

Methods

The PHARMO Record Linkage System includes various data registries including drug dispensing and hospitalizations for ≥2 million subjects in the Netherlands. Patients newly treated with valsartan or enalapril in the period of 1999–2002 were selected. Persistence was calculated by summing up the number of days of continuous treatment. Patients who remained on therapy with valsartan or enalapril for 12 or 24 months were defined as persistent at 1 or 2 years, respectively.

Results

3364 patients received valsartan and 9103 patients received enalapril. About 62% of patients treated with valsartan and 55% of patients treated with enalapril remained on therapy at 12 months after the initial dispensing, while 48% of patients treated with valsartan and 43% of patients treated with enalapril were persistent at 24 months. Patients treated with valsartan were about 20% more likely to stay on treatment than patients treated with enalapril (1 year RR_adj: 1.23, 95% CI: 1.16–1.32; 2 years RR_adj: 1.16, 95% CI: 1.11–1.23).

Conclusions

Real-life persistence is higher with valsartan than with enalapril. The results of this and other studies on persistence in daily practice should be taken into account when deciding upon drug treatment for hypertension.     

Influence of albuminuria and glomerular filtration rate on blood pressure response to antihypertensive drug therapy

Background

Albuminuria and glomerular filtration rate (GFR), two factors linked to kidney and vascular function, may influence longitudinal blood pressure (BP) responses to complex antihypertensive drug regimens.

Methods

We reviewed the clinic records of 459 patients with hypertension in an urban, academic practice.

Results

Mean patient age was 57-years, 89% of patients were African American, and 69% were women. Mean patient systolic/diastolic BP (SBP/DBP) at baseline was 171/98 mmHg while taking an average of 3.3 antihypertensive medications. At baseline, 27% of patients had estimated (e)GFR <60 ml/min/1.73², 28% had micro-albuminuria (30–300 mg/g) and 16% had macro-albuminuria (>300 mg/g). The average longitudinal BP decline over the observation period (mean 7.2 visits) was 25/12 mmHg. In adjusted regression models, macro-albuminuria predicted a 10.3 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 7.9 mmHg lesser longitudinal DBP reduction (p < 0.001); similarly eGFR <60 ml/min/1.73² predicted an 8.4 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 4.5 lesser longitudinal DBP reduction (p < 0.001). Presence of either micro- or macro-albuminuria, or lower eGFR, also significantly delayed the time to attainment of goal BP.

Conclusions

These data suggest that an attenuated decline in BP in drug-treated hypertensives, resulting in higher average BP levels over the long-term, may mediate a portion of the increased risk of cardiovascular-renal disease linked to elevated urinary albumin excretion and reduced eGFR.     

Effect of Powdered Fermented Milk with Lactobacillus helveticus on Subjects with High-Normal Blood Pressure or Mild Hypertension

Objective: Two tripeptides (Val-Pro-Pro and Ile-Pro-Pro) that have inhibitory activities for angiotensin I-converting enzyme are produced in milk fermented with Lactobacillus helveticus. In this study we evaluated the effect and safety of powdered fermented milk with L. helveticus CM4 on subjects with high-normal blood pressure or mild hypertension.

Methods: A randomized, placebo-controlled, double-blind study was conducted using 40 subjects with high-normal blood pressure (HN group) and 40 subjects with mild hypertension (MH group). Each subject ingested 6 test tablets (12 g) containing powdered fermented milk with L. helveticus CM4 daily for 4 weeks (test group) or the same amount of placebo tablets for 4 weeks (placebo group).

Results: During treatment, the decrease in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the test group tended to be greater than in the placebo group for both blood pressure groups. At the end of treatment (week 4), a significant decrease in DBP in the HN group was observed (i.e. 5.0 mm Hg (0.1, 9.9; p = 0.04) compared with the placebo group). There was no significant change in SBP (3.2 mm Hg (95% CI ?2.6, 8.9; p = 0.27). In the MH group, SBP decreased by 11.2 mm Hg (4.0, 18.4; p = 0.003) and there was a statistically non-significant decrease in DBP of 6.5 mm Hg (?0.1, 13.0; p = 0.055) compared with the placebo group. No marked changes were observed in other indexes, including pulse rate, body weight and blood serum variables, and no adverse effects attributed to the treatment was found in each group.

Conclusions: Daily ingestion of the tablets containing powdered fermented milk with L. helveticus CM4 in subjects with high-normal blood pressure or mild hypertension reduces elevated blood pressure without any adverse effects.     

Effect of candesartan cilexetil on diabetic and non-diabetic hypertensive patients: meta-analysis of five randomized double-blind clinical trials

Objective

To study the effect of candesartan cilexetil (CC) in the management of blood pressure (BP) in diabetic and non-diabetic hypertensive patients.

Methods

A selection of five randomized double-blind clinical trials in which patients were treated for hypertension with CC was analyzed. All of these were similar in design: i) a 4-week placebo run-in period, ii) a 4-to 6-week period (V1) with CC 8 mg once daily (od), after which the dosage was doubled if BP was not normalized (BP >140/90 or BP >130/80 mmHg in diabetes), and iii) a 4- to 6-week period (V2) with CC 8 or 16 mg od. Efficacy was measured at V1 and V2.

Results

702 patients were screened. The population consisted of 397 males (56.6%) with a mean age of 60 ± 11 years, with 153 diabetic (21.8%) and 549 non-diabetic (78.2%) patients. At baseline, mean BP values were 160/94/65 mmHg for SPB, DBP, and pulse pressure (PP) respectively, with differences between diabetic and non-diabetic patients. SBP, DBP, and PP values showed a significant reduction at V1 (p < 0.001) and V2 (p < 0.001) compared with baseline for all hypertensive patients. Mean changes at V2 in SBP and PP values were higher in diabetic than non-diabetic patients (p < 0.001), and to a lesser degree on DBP values (p = 0.034).

Conclusions

CC was effective in lowering BP in diabetic and non-diabetic hypertensive patients. CC is a promising therapy to manage hypertensive diabetic patients, as demonstrated by the significant BP reduction.

Short abstract

The effect of candesartan cilexetil (CC) on controlling blood pressure (BP) in hypertensive diabetic and non-diabetic patients was analyzed. Five randomized double-blind trials were pooled treating hypertension by CC (n = 702), including 153 diabetic (21.8%) and 549 non-diabetic (78.2%) patients. After treatment with CC (8–16 mg), significant reductions in SBP, DBP, and pulse pressure (PP) values were observed after 4–6 weeks (p < 0.001) and after 8–12 weeks (p < 0.001) compared with baseline for all hypertensive patients. Mean BP reductions after 8–12 weeks were higher in diabetic patients than non-diabetic (p < 0.001). CC is a promising therapy to treat hypertensive patients, both diabetic and non-diabetic.     

国家医保药物目录遴选的临床证据支持：以甲类抗高血压药物为例

目的：以甲类抗高血压药物为例,了解我国在国家医保药物目录遴选方面的临床证据支持现状,为建立完善的动态药物目录提供依据.方法：以美国和英国的高血压指南、WHO的基本药物目录以及我国在药物开展方面的系统评价或者Meta分析作为我国医保药物遴选的临床证据支持依据.结果：在2009版的国家医保药物目录中,总共有17种甲类抗高血压药物,其中11种甲类抗高血压药物有充分的临床证据支持依据,其它6种缺乏相应的证据支持.结论：部分国家医保药物目录中的甲类抗高血压药物的遴选尚缺乏相应的临床证据支持,应对那些证据力度不高、缺乏证据级别的药物进行相应的评价和更新,从而建立和完善适合我国用药国情、具有较高证据支持的动态医保药物目录机制.     

Differences in Health Services Utilization and Costs between Antihypertensive Medication Users Versus Nonusers in Adults with Diabetes and Concomitant Hypertension from Medical Expenditure Panel Survey Pooled Years 2006 to 2009

ObjectivesTo compare population-level baseline characteristics, individual-level utilization, and costs between antihypertensive medication users versus nonusers in adults with diabetes and concomitant hypertension.MethodsThis longitudinal retrospective observational research used Medical Expenditure Panel Survey household component pooled years 2006 to 2009 to analyze adults 18 years or older with nongestational diabetes and coexistent essential hypertension. Two groups were created: 1) antihypertensive medication users and 2) no antihypertensive pharmacotherapy. We examined average annualized health care costs and emergency department and hospital utilization. Accounting for Medical Expenditure Panel Survey’s complex survey design, all analyses used longitudinal weights. Logistic regressions examined the likelihood of utilization and anytihypertensive medication use, and log-transformed multiple linear regression models assessed costs and antihypertensive medication use.ResultsOf the 3261 adults identified with diabetes, 66% (n = 2137) had concomitant hypertension representing 38.7 million individuals during 2006 to 2009. Significantly, the 16% (n = 338) no antihypertensive pharmacotherapy group showed greater mean nights hospitalized (3.6 vs. 1.7, P = 0.0120), greater all-cause hospitalization events per 1000 patient months (41 vs. 24, P = 0.0.007), and lower mean diabetes-related and hypertension-related ambulatory visits. After adjusting for confounders, non-antihypertensive medication users showed 1.64 odds of hospitalization, 29% lower total, and 27% lower average annualized medical expenses compared with antihypertensive medication users.ConclusionsIn adults with diabetes and coexistent hypertension, we observed significantly greater hospitalizations and lower costs for the non antihypertensive pharmacotherapy group versus those using antihypertensive medications. The short-term time horizon greater hospitalizations with lower expenses among non-antihypertensive medication users with diabetes and concomitant hypertension warrant further study.     

The applicability of home blood pressure measurement in clinical practice: a review of literature

Purpose

To review the literature on home blood pressure measurement (HBPM), to examine its validity and applicability for clinical practice and to provide recommendations regarding HBPM assessment.

Findings

HBPM can eliminate the white coat effect and offers the possibility to obtain multiple measurements under standardized conditions, which increases knowledge of overall blood pressure value. Although it is not entirely capable of replacing ambulatory blood pressure measurement (ABPM), HBPM correlates better with target organ damage and cardiovascular mortality than office blood pressure measurement (OBPM), it enables prediction of sustained hypertension in patients with borderline hypertension, and proves to be an appropriate tool for assessing drug efficacy. Additional advantages of HBPM are that it may increase drug compliance and patient’s awareness of hypertension. Overall, OBPM yield higher blood pressure values than HBPM. Differences between OBPM and HBPM tend to increase with age and are generally higher in patients without antihypertensive treatment than in patients with antihypertensive treatment.

Recommendations

Measurements should be performed according to accepted guidelines and recordings should be performed with a memory equipped automatic validated device. From the data reviewed here, we recommend that HBPM be assessed monthly by taking two measurements in the morning within 1 hour after awakening and two in the evening for three consecutive days, the data from the first day should be dismissed. A subject should be labeled hypertensive if his/her HBPM value is equal to or greater than 137 mmHg systolic and/or 84 mmHg diastolic.     

Acute Effects of Cocoa Flavanols on Blood Pressure and Peripheral Vascular Reactivity in Type 2 Diabetes Mellitus and Essential Hypertension

Background: Type 2 diabetes mellitus (T2DM) is associated with a high risk of vascular complications. Interestingly, cocoa flavanols (CF) can exert beneficial vascular effects in non-diabetic subjects. However, these effects have only been scarcely studied in T2DM. Therefore, we performed a study to assess the effects on vascular reactivity of a single dose of CF (790 mg) in T2DM and whether certain antihypertensive drugs may modulate these effects. Methods: 24 non-diabetic and 11 T2DM subjects were studied in a cross-over design. Fasting blood samples, blood pressure (BP), and arterial vasoreactivity (flow-mediated dilation) were assessed before and 70 min after capsule ingestion. Muscle microvascular reactivity was only assessed after capsule ingestion. Age, waist-to-hip ratio, BP at baseline, and the use of antihypertensive drugs were regarded as covariates in a mixed models analysis. Results: CF ingestion did not affect any parameter. However, independent of the type of capsules ingested, a decrease in diastolic BP by 3 mmHg (95% CI: −4.0; −2.0) and an increase in the change in brachial artery diameter (pre vs. post occlusion) by 0.06 mm (95% CI: 0.01; 0.12) were detected in the non-diabetic group, while they remained unchanged in the T2DM group. Conclusion: No beneficial effects of CF were detected on vascular reactivity parameters in T2DM and non-diabetic participants.     

2002年中国部分民族高血压患病情况

目的了解中国部分民族的高血压患病、血压水平情况。方法数据来源于2002年中国居民营养与健康状况调查,数据共包括15岁以上人群152683例,其中男性67700例,女性84983例。结果按1964年人口年龄构成标化后,男性高血压患病率最高的两个民族为藏族(25·6%)和满族(23·1%),最低的两个民族为苗族(9·2%)和土家族(11·1%),女性高血压患病率最高的两个民族也为藏族(24·0%)和满族(18·7%),而患病率最低的两个民族为苗族(6·1%)和壮族(8·3%)。与1991年相比除蒙古族的男性和苗族的女性高血压标化患病率有所下降外,其他各民族无论男女高血压患病率均升高。结论高血压的患病及血压水平在所调查的民族间各不相同,与1991年相比,几乎所有调查民族的高血压患病率均有不同程度的升高。     

长期饮酒对男性高血压降压疗效和血压昼夜节律的影响

目的探讨长期饮酒对男性高血压患者药物降压疗效和血压昼夜节律的影响。方法91例男性原发性高血压患者,根据饮酒情况分为饮酒组45例、戒酒组15例和不饮酒组31例。缬沙坦治疗8周,观察治疗前后血压和动态血压变化。结果治疗前饮酒组夜间平均收缩压、夜间收缩压负荷高于不饮酒组（P〈0．05～0．01）,治疗后各组血压均有显著降低（P〈0．001）,但饮酒组夜间血压下降幅度低于不饮酒组,24h平均收缩压、日间平均收缩压、日间收缩压负荷高于戒酒组（P〈0．05～0．01）。治疗后饮酒组非杓型血压比例减少（P〈0．05）,人均缬沙坦和双氢克尿噻用量大于戒酒组和不饮酒组（P〈0．05～0．01）。结论长期饮酒可使异常血压昼夜节律增加,降低疗效,增加药量,因此应加强高血压患者健康宣教,限制酒精的摄入。     

不同降压药物联合治疗对老年高血压患者血压变异性的影响

目的探讨培哚普利联合氨氯地平或氢氯噻嗪对老年高血压患者血压变异性的影响。方法选取2018年1月-2019年1月于北京市某医院收治的80例老年高血压患者为研究对象,采用随机数字表法分为对照组与研究组,每组40例。对照组患者采用培哚普利联合氢氯噻嗪口服治疗,研究组患者采用培哚普利联合氨氯地平口服治疗,2组患者均治疗8周。比较治疗前后2组患者的白天平均收缩压(dSBP)、夜间平均收缩压(nSBP)、24 h平均收缩压(24 h SBP)、24 h平均收缩压变异系数(24 h SCV)、白天平均收缩压变异系数(dSCV)、夜间平均收缩压变异系数(nSCV),白天平均舒张压(dDBP)、夜间平均舒张压(nDBP)、24 h平均舒张压(24 h DBP)、24 h平均舒张压变异系数(24 h DCV)、白天平均舒张压变异系数(dDCV)、夜间平均舒张压变异系数(nDCV),血管内皮功能相关指标[内皮素(ET)、一氧化氮(NO)、一氧化氮合成酶(eNOS)、颈动脉内膜中层厚度(IMT)、反应性充血后血管内径变化率(FMD)]变化,同时比较2组患者的不良反应、并发症发生情况。结果治疗前,2组患者24 h SBP,dSBP,nSBP,24 h SCV,dSCV及nSCV比较,差异均无统计学意义(P>0.05);治疗后,2组患者24 h SBP,dSBP,nSBP,24 h SCV,dSCV及nSCV均低于治疗前,且研究组明显低于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者24 h DBP,dDBP,nDBP,24 h DCV,dDCV及nDCV比较,差异均无统计学意义(P>0.05);治疗后,2组患者24 h DBP,dDBP,nDBP,24 h DCV,dDCV及nDCV均低于治疗前,且研究组24 h DCV,dDCV,nDCV明显低于对照组,差异均有统计学意义(P<0.05);治疗前,2组患者ET,NO,eNOS,IMT及FMD水平比较,差异均无统计学意义(P>0.05);治疗后,2组患者ET、IMT水平低于治疗前,且研究组明显低于对照组,差异均有统计学意义(P<0.05);2组患者NO,eNOS及FMD水平高于治疗前,且研究组明显高于对照组,差异均有统计学意义(P<0.05);2组患者治疗期间均未发生药物不良反应及严重并发症。结论培哚普利联合氨氯地平或培哚普利联合氢氯噻嗪均可有效治疗老年高血压,能够安全、有效地控制患者的血压水平、降低老年高血压患者的血压变异性,但培哚普利联合氨氯地平的治疗疗效更为理想。临床可根据患者实际病情,选择恰当的药物治疗方案,提升老年高血压治疗的有效性、安全性。     

不同类型降压药物对老年高血压患者动脉僵硬度的影响

目的评价不同类型降压药物对老年原发性高血压患者动脉僵硬度的影响。方法60例老年男性原发性高血压患者,随机分为缬沙坦组（80mg,l/d）、贝那普利组（10mg,l/d）、硝苯地平缓释片组（20mg,2／d）各20例,疗程共3个月。分析治疗前后肱一踝脉搏波速度（baPWV）及血压。结果治疗3个月后各组血压均有显著降低,硝苯地平缓释片组舒张压的下降幅度（△DBP）、脉压下降幅度（△PP）与另两组差异显著（分别为-40．1±11．3 vs-16．6±5．5、-14．6±4．2mmHg和-10．0±19．3vs -28．8±6．6、-25．7±6．5mmHg,P〈0．01）。缬沙坦组及贝那普利组治疗前后baPWV均显著下降,其下降幅度（AbaPWV）分别为-401±90、-280±97cm／s,显著大于硝苯地平缓释片组的-11±127cm／s（P〈0．01）。baPWV与APP在总体患者中呈显著正相关（r=0．64．P〈0．001）,贝那普利组或硝苯地平缓释片组ΔbaPWV至少与一项血压参数（APP,ASBP,ADBP）相关,而在缬沙坦组均不相关。结论与贝那普利或硝苯地平缓释片相比,缬沙坦对老年原发性高血压患者具有独立于降压功效外的减低动脉僵硬度的作用。     

2014—2016年北京市20所高校社区医院口服抗高血压药物使用情况分析

目的 了解北京高校社区医院抗高血压药物的使用情况。方法 采用回顾性方法,对2014—2016年北京20所高校社区医院采购的社区零差价药品中口服抗高血压药物的品种、数量、用药频度(DDDs)、日均费用(DDC)等进行统计分析。结果 2014—2016年20所高校社区医院采购的抗高血压药物采购金额占化学药品采购金额分别为36.03%、34.20%、33.25%。采购金额、DDDs排序均居前2位的是钙通道阻滞剂、β受体拮抗剂,而血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂的销售金额、DDDs相对稳定,利尿剂、传统复方制剂呈下降趋势。钙通道阻滞剂中,苯磺酸氨氯地平片、硝苯地平控释片、左旋氨氯地平片销售金额、DDDs 排序居前3位。结论 抗高血压药已成为20所高校社区医院消耗医疗资源较多的一类药,医院口服抗高血压药的使用情况基本符合《中国高血压防治指南基层版》(2017年版)用药原则,钙通道阻滞剂占主导地位。     

抗高血压药物在慢性脑血管病患者中的血压变异性影响

目的探讨不同类的降压药物和不同钙拮抗剂对慢性脑血管病患者中血压变异性的影响。方法入选373例有慢性脑血管病的高血压患者,分别给予钙拮抗剂(CCBs)、(受体阻断剂(BBs)、血管紧张素转换酶抑制剂(ACEIs)和血管紧张素Ⅱ受体拮抗剂(ARBs)治疗后,行24h动态血压计算血压变异性,并进行统计分析。结果 BBs的日间血压变异性明显高于ARB或CCB(P<0.05),相比于其他CCB药物,西尼地平的日间血压变异性最低。结论 ARB和CCB相比于BBs更有利于脑血管疾病患者的高血压管理和治疗。而CCB中,由于较小的血压变异性,优选西尼地平。     

Blood pressure in vegetarians and non-vegetarians: A cross-sectional analysis

The purpose of this study was to examine the relationship between dietary status and blood pressure (BP) in a population of adult Seventh Day Adventists attending a statewide church conference. A total of 215 conferees ( age=52 yrs.) volunteered to complete a lifestyle questionnaire (LSQ) designed to obtain information on selected demographic and psychosocial variables, medical history, and dietary and other health-related habits. Height and weight were measured, and a minimum of two blood pressure readings using a random baseline mercury sphygmomanometer were taken from each individual by observers blind to the participants' LSQ responses. Participants were divided into vegetarian and nonvegetarian categories hased on self-reported dietary habits. Significantly fewer (X²=14.4, p<.001) vegetarians (n=21, 14.0%) reported a history of physician-diagnosed hypertension compared to non-vegetarians (n=24, 36.9%). All subjects taking prescribed antihypertensive medications and antihistamines were excluded from further analysis (n=27). An analysis of variance showed that blood pressure of vegetarians (n=135, =114/71) was significantly lower (p<.05) than the BP of the non-vegetarians (n=53, =122/74). When blood pressures were adjusted for the covariates of age, sex, and body mass index, there was no significant difference in blood pressure between the two groups. Further analyses revealed that the lower BP in the vegetarians appeared to be best explained by their lower body mass index.     

Effects of antihypertensive drugs atenolol and nifedipine on sexual function in older men: A placebo-controlled,crossover study

Investigated the adverse sexual effects of two antihypertensive drugs, atenolol and slow-release nifedipine, in a placebo-controlled, randomized, crossover study. Subjects were 16 older men (mean age = 66.6 years, SEM = 1.4) with mild to moderate hypertension. Subjects completed daily self-reports on 13 measures of sexuality: frequency of desire, coitus, noncoital partner sex, masturbation, morning erections, spontaneous erections, orgasms in coitus and masturbation, firmness of morning, masturbatory and coital erections, and subjective pleasure in coitus and masturbation. Except for a significant decrease in masturbatory erectile firmness with nifedipine therapy, variables did not differ between the two drug treatments or between either drug and placebo. Although the sample was relatively small, small differences between treatment means suggest that these antihypertensive agents are fairly benign relative to sexual function in men.Supported by NIH grants DK07217-12A1 and AGO1437.Dr. Hoffman is an Established Investigator of the American Heart Association     

Vitamin D and blood pressure connection: update on epidemiologic, clinical, and mechanistic evidence

Hypertension is an important risk factor for cardiovascular and kidney disease. High blood pressure is a growing public health problem that is expected to affect 1.6 billion people worldwide by the year 2025. In light of emerging evidence of a widespread global problem of vitamin D deficiency, there has been increasing interest concerning the role of vitamin D in chronic disease. The recent publication of several studies, highlighted in this brief review, supports an association between vitamin D status and blood pressure. It remains to be determined what level of vitamin D status needs to be achieved in different subpopulations to assure the maximum benefit of vitamin D status on blood pressure.     

重度子痫前期降压药物的研究进展

]妊娠期高血压疾病是妇女妊娠期常见的并发症,重度子痫前期为妊娠期高血压疾病的严重阶段,当孕妇血压≥21.3/14.7kPa(160/110mmHg)时,可能导致心肌梗死、脑出血、肾脏功能不全或衰竭、胎盘早剥或胎死宫内的发生,其严重地威胁着母婴健康.因此,降压治疗在重度子痫前期的治疗中起着关键作用.该文就近来治疗重度子痫前期降压药物的研究进展作以综述.     

Impact of Interventions on Medication Adherence and Blood Pressure Control in Patients with Essential Hypertension: A Systematic Review by the ISPOR Medication Adherence and Persistence Special Interest Group

ObjectivesTo systematically review the evidence on the impact of interventions to improve medication adherence in adults prescribed antihypertensive medications.MethodsAn electronic search was undertaken of articles published between 1979 and 2009, without language restriction, that focused on interventions to improve antihypertensive medication adherence among patients (≥18 years) with essential hypertension. Studies must have measured adherence as an outcome of the intervention. We followed standard guidelines for the conduct and reporting of the review and conducted a narrative synthesis of reported data.ResultsNinety-seven articles were identified for inclusion; 35 (35 of 97, 36.1%) examined interventions to directly improve medication adherence, and the majority (58 of 97, 59.8%) were randomized controlled trials. Thirty-four (34 of 97, 35.1%) studies reported a statistically significant improvement in medication adherence.Discussion/ConclusionsInterventions aimed at improving patients’ knowledge of medications possess the greatest potential clinical value in improving adherence with antihypertensive therapy. However, we identified several limitations of these studies, and advise future researchers to focus on using validated adherence measures, well-designed randomized controlled trials with relevant adherence and clinical outcomes, and guidelines on the appropriate design and analysis of adherence research.