基层医院高血压患者的药物治疗和血压控制情况调查分析

目的了解基层医院对高血压患者治疗的规范性和有效性。方法对北京市大兴区长子营镇中心卫生院于2013年1月~2015年12月间,604例高血压患者降压药物使用及血压控制情况进行回顾性分析。降压药物分三类:推荐制剂、传统制剂、中药制剂。推荐制剂即《中国高血压基层管理指南》推荐降压药:血管紧张素转换酶抑制剂(ACEI)、血管紧张素II受体拮抗剂(ARB)、β受体阻滞剂(βRB)、钙通道阻滞剂(CCB)和利尿剂(HCTZ);传统制剂:降压0号、复方利血平等;中药制剂:清肝降压胶囊、牛黄降压胶囊等。平均治疗时间为12.31±5.54 d,治疗后连续3 d血压≤140/90mm Hg为血压达标(1 mm Hg=0.133k Pa);达标率=达标患者数/治疗人数×100%。结果 604例患者年龄在40~96岁之间,平均(63.44±10.12)岁;其中男性259例,女性345例;平均高血压病程为8.5±8.2年;住院时限为10~20 d,治疗后血压不同程度降低,收缩压从入院时的151.9±15.6 mm Hg,到治疗后的128.5±8.0 mm Hg;舒张压从91.7±9.8 mm Hg降到79.6±4.9 mm Hg。总体达标率为98.5%,高血压1~3级患者达标率分别为100%,99.4%,97.82%。在药物的使用方面563例选择推荐制剂占93.2%,31例使用传统制剂+推荐制剂占5.1%,10例使用中药制剂+推荐制剂占1.6%。推荐制剂使用中,单种制剂、两种制剂和三种制剂分别为54.88%,40.6%和4.4%。单种推荐制剂使用中67.6.1%为CCB,两种制剂联合使用者86.4%为CCB+ACEI/ARB。三种制剂联合使用中68.0%为ACEI+ARB+βRB,4%为CCB+ACEI+ARB。结论基层医院住院患者高血压治疗总体规范,达标率高达98%以上;93%以上的患者使用了推荐制剂,单一和二联制剂使用规范,三种制剂的联合用药的选择上存在作用机制相同的药物重复使用,有一定局限性,可能是少数患者血压不达标的原因。     

顽固性高血压原因分析及治疗对策

报告104例顽固性高血压患者,主要原因为顺从性不好32例,重视并发症治疗而忽视降压治疗31例,继发性高血压11例,合并症急性发作时药物互相拮抗8例,单纯高血压未注意生活干预22例.其治疗原则是在生活干预基础上调整并联用降压药物,其中利尿剂 血管紧张素转化酶抑制剂(ACEI) 钙离子拮抗剂(CCB)68例,利尿剂 CCB β受体拮抗剂(βRB)13例,CCB βRB 血管紧张素Ⅱ受体拮抗剂(ARB)10例,利尿剂 ACEI CCB βRB13例.结果经调整降压药物治疗后,血压降至正常96例,控制不理想8例.提示分析顽固性高血压原因,在生活干预基础上去除诱发因素,调整降压治疗方案,足量联用降压药物,可有效控制顽固性高血压.     

《特殊类型高血压临床诊治要点专家建议》中高血压合并相关心血管疾病降压治疗推荐(一)

高血压合并室上性心律失常1心房颤动降压治疗高血压伴心房颤动患者的降压治疗原则包括降低血压和降低左心房负荷。对于心房颤动患者首选以下几类降压药:(1)血管紧张素转换酶抑制剂(ACEI)、血管紧张素Ⅱ受体拮抗剂(ARB):国内外指南均推荐ACEI和ARB用于预防心房颤动的发生和进展,单药控制不良时,优先推荐ACEI/ARB与钙离子通道阻滞剂(CCB)或噻嗪类利尿剂联用。     

不同降压药物对痛风合并高血压患者代谢指标的影响

目的探讨痛风合并高血压患者同一高血压分级情况下服用不同种类降压药物对其代谢指标的影响。方法选取未行降压治疗或规律服用单一种类降压药物8周以上的痛风合并高血压患者902例,按照血压水平将其分为3组;比较3组高血压患者临床指标的差异及同一高血压等级患者在分别服用利尿剂、β受体阻滞剂、钙通道阻滞剂(CCB)、血管紧张素转化酶抑制剂(ACEI)及血管紧张素Ⅱ受体阻滞剂(ARB)进行降压治疗后的临床指标变化。结果随着血压水平的增高,受试者体质量指数(BMI)、血糖(PG)、甘油三酯(TG)、总胆固醇(TC)、尿素氮(BUN)、肌酐(Cr)、尿酸(SUA)均呈上升趋势;1级高血压患者中,利尿剂组TG、Cr显著高于未用药组,CCB、ACEI及ARB组TG、BUN、Cr、SUA水平显著低于利尿剂组,ARB组尿酸排泄分数(FEUA)较其他各组显著升高(P均<0.05);2级高血压患者中,CCB、ACEI、ARB组与利尿剂组及β受体阻滞剂组相比SUA降低,ACEI及ARB组较其他各组Cr降低,ARB组较其他各组FEUA升高(P均<0.05);3级高血压患者中ACEI及ARB组TG、SUA、Cr低于利尿剂组,ARB组FEUA显著高于其他各组(P均<0.05)。结论痛风合并高血压患者应根据自身情况正确选择降压药物。     

《特殊类型高血压临床诊治要点专家建议》中高血压合并相关心血管疾病降压治疗推荐

正高血压合并室上性心律失常1心房颤动降压治疗高血压伴心房颤动患者的降压治疗原则包括降低血压和降低左心房负荷。对于心房颤动患者首选以下几类降压药:(1)血管紧张素转换酶抑制剂(ACEI)、血管紧张素Ⅱ受体拮抗剂(ARB):国内外指南均推荐ACEI和ARB用于预防心房颤动的发生和进展,单药控制不良时,优先推荐ACEI/ARB与钙离子通道阻滞剂(CCB)或噻嗪类利尿剂联用。(2)β-受体阻滞剂:对于高血压伴心房颤动患者,β-受体阻滞剂可以控制发作时心室率、促进心房颤动转复为窦性心律和维持窦性心律,以及减少心房颤动复发。但对于伴心功能不全的患者应首先评估心功能情况;禁用于伴有预激综合征的心房颤动患者。(3)非二氢吡啶类CCB:对于需要控制心率的心房颤动患者,一线治疗药物为β-受体阻滞剂和非二氢吡啶类CCB(地尔硫和维拉帕米),但一般情况下不推荐两者联用。对不伴有收缩功能不全的心房颤动合并高血压患者,急性期心室率控制可采用缓慢静脉注射地尔硫注射液或维拉帕米注射液。禁用于伴有预激综合征的心房颤动患者。2其他类型室上性心律失常高血压合并其他类型的室上性心律失常如下:(1)病态窦房结综合征及房室传导紊乱:建议排除阻塞性睡眠呼吸暂停综合征并给予治疗。     

二异丙酚诱导对老年原发性高血压患者血压和心率的影响

目的 比较二异丙酚静脉诱导对不同抗高血压药治疗后患者血压和心率的变化.方法 选择单纯使用血管紧张素转换酶抑制剂(ACEI)、血管紧张素Ⅱ受体拮抗剂(ARB)、钙拮抗剂(CCB)、β受体阻滞剂的择期行腹部手术的老年原发性高血压患者各15例,分别测定各患者术前基础血压值和二异丙酚静脉注射后患者睫毛反射消失后60 s血压值和心率变化.结果 与基础值比较,各组患者血压和心率均显著降低(P＜0.01);与β受体阻滞剂组比较,诱导后ACEI和ARB组血压和心率均显著降低(P＜0.01).与CCB组比较,诱导后ACEI和ARB组血压均显著降低(P＜0.01),ARB组心率显著低于CCB组(P＜0.01).结论 在对使用ACEI和ARB对老年原发性高血压患者进行麻醉诱导时,应降低二异丙酚的诱导剂量或避免使用抑制循环的药物,以免造成严重低血压.     

高血压心力衰竭防治的新观念

高血压是心力衰竭(简称心衰)的主要归因危险,而大多数心衰患者均有高血压史。长期高血压使肾素-血管紧张素-醛固酮系统(RAAS)和交感神经系统过度兴奋;又是促进冠脉粥样硬化的主要危险因素。降压治疗可以预防和治疗心衰。降压目标水平为130/80mmHg。ACEI、ARB、β-受体阻滞剂和利尿剂均适用此类患者,通常需2～3种药物合用。其中ACEI(或ARB)加β-受体阻滞剂的合用最受推荐。钙拮抗剂(CCB)一般不用,但长作用二氢吡啶类CCB如氨氯地平或非洛地平已证实不会使心衰加重或预后恶化。收缩性心衰在利尿剂基础上应长期使用ACEI(或ARB)和β-受体阻滞剂,可降低病死率;舒张性心衰亦可应用这些药物,但只能改善症状。     

慢性肾脏疾病合并高血压处理的策略

控制高血压是控制慢性肾脏病最重要、最有效的手段。与一般无肾脏病变的高血压患者相比,其血压要求控制更严格。处理的原则是:优先考虑是否能降低血压,同时充分考虑各类降压药对具体患者的情况,包括血压过高的程度,突然或长久上升,心肾功能情况,有否重要代谢异常等加以选择。在现有推荐的降低高血压药物中,利尿剂效果常受肾功能下降影响,ACEI/ARB类对合并蛋白尿者似较优越,但对严重肾功能减退者须慎用。CCB降压效果好并且作用快,常是达到降压目标的包含用药。β受体阻滞剂在肾脏病高血压时不作为主要用药。联合用药在肾脏病合并高血压时十分常见,ACEI或ARB加利尿剂,ACEI或ARB+CCB为最常见的组合。ACEI+ARB虽然对蛋白尿有好处,但是严重心血管并发症者应注意。在高血压治疗过程中必须注意个体差异,治疗方案必须视反应情况作出调整。限制食盐摄入常是肾脏病高血压治疗成功与否的另一关键。     

北京社区管理的高血压患者降压药物应用情况分析

目的:了解北京社区管理的高血压患者药物治疗及血压控制情况。方法:对北京市45家社区卫生服务中心4 520名管理的高血压患者进行问卷调查,了解患者血压控制现状,危险因素、伴随疾病以及药物治疗信息。结果:社区就诊患者73.6%为65岁老年人,53.3%为心血管病高危患者。采用两种以上药物治疗的患者仅占26.4%,在高危患者以及伴有冠心病的患者中采用联合治疗的患者仍然低于单一服药的患者。在服药患者中,两种药物的联合用药以血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)和β受体阻滞剂联合应用的者最多(10.5%),其次为ACEI/ARB和钙离子拮抗剂(CCB)的联合应用(7.7%)。ACEI/ARB的服用率最高(54.6%),其次为β受体阻滞剂(39.7%)和CCB(31.1%)。采用两种以上药物治疗的患者血压总体控制率和单一药物治疗者相比没有明显优势(48.3%,53.1%,χ~2=3.325,P=0.068),但ACEI/ARB分别与β受体阻滞剂和CCB联合应用血压控制率高于单用或与其它药物联合以及不用此类药物的其他药物治疗。结论:北京市社区管理的高血压患者尤其是心血管病高危患者采取联合治疗的比例低。ACEI/ARB的服用率最高,不同于其他同类人群以利尿剂应用为主。药物联合的方案还需要优化,联合治疗的降压效果还需要提升。     

高血压的降压药物治疗——从ALLHAT临床试验得到的启迪

高血压降压药物治疗已取得重要进展 ,传统的降压药物噻嗪类利尿剂和 β阻滞剂降压治疗的受益早已得到确认。近年来 ,一些新的降压药例如血管紧张素转换酶抑制剂 (ACEI)、钙拮抗剂 (CCB)、α受体阻滞剂及血管紧张素受体拮抗剂 (ARB)又相继应用于临床 ,ACEI和CCB与安慰剂的随机双盲对照试验已证实其在高血压患者可降低心血管事件 ,但这些新的药物是否比价格明显低廉的传统药物具有更多的优越性尚不明了。2 0 0 2年 12月在JAMA杂志发表的“降血压和降血脂预防心肌梗死临床试验 (anti hypertensiveandlipidloweringtopreventheartattac…     

高血压联合降压治疗与动脉弹性的关系

目的了解以钙通道阻滞剂（CCB）为基础的不同降压药物联合治疗方案在降压达标后对中老年高血压患者动脉弹性的影响,评估其防治心脑血管危险的效果。方法 156例中老年高血压患者被随机分为两组,经5～7d药物洗脱期后分别接受CCB＋血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）以及CCB＋利尿剂（D）联合治疗,4周常规剂量治疗后血压未达标者加用小剂量β受体阻滞剂（β-B）至血压达标。治疗前和治疗后1年分别检测治疗组患者血压、心率、大动脉弹性指数（C1）和小动脉弹性指数（C2）,比较各治疗组间血压、心率、C1和C2的变化。以36例中老年健康者1年前后的C1和C2为对照,排除因增龄所致的动脉弹性改变。结果①各治疗组治疗后收缩压、舒张压、脉压均明显降低,差异有统计学意义（P均〈0.01）。②治疗后CCB＋ACEI/ARB＋β-B（C＋A＋B）组和CCB＋D＋β-B（C＋D＋B）组心率明显减慢,差异有统计学意义（P均〈0.01）;CCB＋ACEI/ARB（C＋A）组心率减慢,差异有统计学意义（P〈0.05）。③治疗后C＋A组C1减小,差异有统计学意义（P〈0.05）;治疗后C＋A＋B组和C＋D＋B组C2均增大,P〈0.05,差异有统计学意义。④健康对照组1年前后各项指标血压、心率、C1和C2均无变化（P〉0.05）。结论在降压达标情况下,C＋A和C＋D联合治疗对中老年高血压患者的动脉弹性无明确改善,C＋A＋B和C＋D＋B联合治疗可改善中老年高血压患者的小动脉弹性,小剂量β受体阻滞剂与其它常用降压药物联用对中老年高血压患者动脉弹性改善有益。     

高龄男性原发性高血压患者降压药物应用现状

目的探讨高龄男性原发性高血压患者的降压药物治疗现状,为临床治疗提供参考。方法对106例75岁以上男性原发性高血压患者出院时降压药物应用方案进行登记并行χ2检验。结果应用最多的是长效钙离子拮抗剂(CCB,77.35%)、其次是β受体阻滞剂(46.23%)、血管紧张素转换酶抑制剂(40.57%)、血管紧张素Ⅱ受体拮抗剂(28.30%)、利尿剂(26.42%)和α受体阻滞剂(0.94%),长效CCB明显高于其他种类降压药物,有78.31%的患者需要两种以上降压药物的联合治疗,平均服降压药物种类(2.19±0.86)种例。结论高龄男性原发性高血压患者适用于以长效CCB为基础的小剂量联合降压治疗方案,而利尿剂不是其一线药物。     

Incident Stroke Events in Clinical Trials of Antihypertensive Drugs in Cardiovascular Disease Patients: A Network Meta-analysis of Randomized Controlled Trials

Antihypertensive drugs are commonly used in cardiovascular diseases (CVD), less is known about the comparative effectiveness of different antihypertensive drugs on stroke events in CVD patients. We searched MEDLINE, EMBASE, the Cochrane Library, and the Web of Science for randomized controlled trails comparing the different antihypertensive drugs for stroke events in CVD patients from inception until November, 2022. Pairwise and network meta-analysis were performed to compare of different antihypertensive drugs for the incidence of stroke events in CVD patients. The protocol was registered on the PROSPERO database (CRD42022375038). 33 trials involving 141,217 CVD patients were included. The incidence of stroke in CVD patients for each antihypertensive drugs was placebo (3.0%), ACEI (2.4%), ARB (4.1%), CCB (1.8%), β blocker (1.3%), and diuretic (3.6%). Antihypertensive drug was significantly reducing stroke events in CVD patients when compared with placebo (OR 0.82; 95% CI 0.75 to 0.89). Specifically, ACEI (OR 0.82; 95% CI, 0.69-0.97), ARB (OR 0.87; 95% CI, 0.77-0.98), CCB (OR 0.69; 95% CI, 0.54-to 0.87), and diuretic (OR 0.74; 95% CI, 0.57-0.95) were significantly reducing stroke events in CVD patients when compared with placebo. Network meta-analysis suggested CCB and diuretic ranked the first and second in reducing the incidence of stroke events in CVD patients with the SUCRA value of 90.9% and 73.8%. CCB and diuretic had the greatest possibility to reduce the incidence of stroke events in CVD patients, while, ACEI was the worst antihypertensive agents in reducing the incidence of stroke events in CVD patients.     

高血压门诊患者22399例分析

目的分析在首都医科大学附属复兴医院门诊各科室就诊的高血压患者数量、分布情况、用药情况以及药费金额,分析β受体阻滞剂在该院使用的各类降压药中所处的地位。方法利用"东华医院信息系统"门诊医师工作站收集复兴医院2007年7月26日至2008年1月31日门诊各科室收治22399例高血压患者的性别、年龄、血压分级等就诊资料及用药情况、药费金额。将患者就诊科室分为心血管内科、非心血管内科、非内科专业3个组,根据医院门诊药房备药情况将降压药物分为β受体阻滞剂、α受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)、血管紧张素受体拮抗剂(ARB)、钙拮抗剂、利尿剂、中成药、传统复方降压药物8类。分析3组患者血压分级、年龄、性别等一般资料,不同类型降压药物使用情况及药费金额之间的差异。结果在门诊就诊的女性高血压患者多于男性患者(53.77%vs46.33%),心血管内科组高血压3级患者明显多于非心内科组及非内科专业组(P0.001),其西药费次均金额亦最高(296.75元),而中成药次均金额最少(0.00元)。在非内科专业组中,中成药次均金额明显多于西药费(P0.001)。在非心内科组与非内科专业组中处方量最大的前3种降压药物依次为钙拮抗剂、β受体阻滞剂、ACEI,心血管内科门诊处方量最大的降压药物依次为β受体阻滞剂、钙拮抗剂、利尿剂。结论心内科医师更多地在指南范围内选择降压药物,心血管内科组在降压治疗中中成药使用量明显少于非心内科组及非内科专业组。目前在复兴医院β受体阻滞剂仍作为一线降压药物被使用。     

Effects of monotherapy of temocapril or candesartan with dose increments or combination therapy with both drugs on the suppression of diabetic nephropathy.

We examined the effects of increasing the recommended initial doses of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), or of switching to combination therapy with both drugs, on diabetic nephropathy. Hypertensive type 2 diabetic patients with urinary albumin excretion (ACR) between 100 and 300 mg/g creatinine (Cre) were assigned to the following five groups in which an antihypertensive drug was administered at a recommended initial dose for 48 weeks, and then either the dose was doubled or an additional drugs was added to regimen for the following 48 weeks: N, nifedipine-CR (N) 20 mg/day (initial dose); T, ACEI temocapril (T) 2 mg/day; C, ARB candesartan (C) 4 mg/day; T+C, T first and then addition of C; C+T, C first and then addition of C. ACR decreased in the T (n=34), C (n=40), T+C (n=37) and C+T (n=35) groups, but not in the N group (n=18). However, the anti-proteinuric effect was less in the T than in the C, T+C or C+T groups, while no differences existed among the latter three. In each group, there were significant linear relationships between attained BP and ACR; however, the regression lines were shifted toward lower ACR level in the renin-angiotensin system-inhibition groups compared with the N group. These results indicate that an ACEI and/or ARB is superior to a CCB in retarding diabetic nephropathy, while the combination of low doses of ACEI and ARB has effects similar to those of high-dose ARB. Even among patients treated with an ACEI and/or ARB, lowering BP is important.     

Patterns of antihypertensive therapy among patients with diabetes

BACKGROUND: Hypertension is extremely prevalent in patients with diabetes. Limited data exist on whether patterns of antihypertensive use in this population are consistent with evidence-based practice guidelines. OBJECTIVE: To evaluate utilization patterns of antihypertensive agents and blood pressure (BP) control among diabetic patients with hypertension. DESIGN: Retrospective cohort study. PATIENTS/PARTICIPANTS: In all, 9,975 patients with diabetes and hypertension as of March 2001 from an outpatient medical center of the Department of Veterans Affairs. MEASURES: Proportions of use of 6 different antihypertensive drug classes were compared for all patients receiving 1, 2, 3, or 4 or more drugs, and separately among patients with and without coronary artery disease (CAD). Blood pressure control (<130/85 mmHg) was compared for untreated patients, those on monotherapy, and patients on multi-drug regimens. RESULTS: Over 60% of patients were receiving angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB), followed by diuretics (38.1%), calcium channel blockers (35.3%) and beta-blockers (28.5%) with 19.1% of patients untreated. Patients on monotherapy were mostly receiving ACEI/ARB (59.5%). The majority (70.7%) of treated patients were on multidrug regimens. In patients with CAD, beta-blocker and ACEI/ARB use was higher, and 70.5% of patients on single-drug regimens received either ACEI/ARB or beta-blockers. The proportions of patients not on medications, on monotherapy, or multidrug regimens achieving BP control were 23.4%, 27.4%, and 24.9%, respectively. CONCLUSIONS: Patterns of anti-hypertensive therapy were generally consistent with evidence-based practice guidelines. Areas of improvement include increasing ACEI/ARB and diuretic use, decreasing the number of untreated patients, and increasing the proportion of patients with controlled BP in this population.     

Évaluation par l’automesure au domicile de l’efficacité de monothérapies antihypertensives chez des hypertendus traités en France

ObjectiveTo evaluate the blood pressure (BP) control and the efficacy of antihypertensive monotherapy using home BP self-measurement in a French population of treated hypertensive subjects in 2007 2009 and 2010.MethodsThe French League Against Hypertension Surveys (FLAHS) are conducted among a representative sample of individuals aged 35 years and older living in France. For the 2007, 2009 and 2010 surveys, a sample of 1467 subjects who owned a BP self-measurement device and performed three consecutive morning BP measurements were included. Among the 60% of subjects who reported taking at least one antihypertensive drug, we analyzed subjects treated with one of the following antihypertensive monotherapy, i.e., beta-blocker (BB), ACE inhibitors, calcium channel blocker (CCB) and angiotensin receptor blockers (ARB).ResultsAmong treated hypertensive subjects (n = 886), 66% (n = 586) had home BP below the 140/90 mmHg threshold and 50% (n = 449) below 135/85 mmHg. Three hundred two subjects were treated with a single antihypertensive drug, 33% had ARB, 25% BB, 19% CCB and 13% ACE inhibitors. Age (years) for each treatment group is different (P < 0.01) CCB (72.1 ± 9.3), BB (65.6 ± 9.8), ARB (68.6 ± 8.9) and ACEI (67.3 ± 10.2). The mean systolic/diastolic BP (mmHg) is not comparable between monotherapy 130.7/76.1 (ARB), 130.7/78.7 (BB), 134.0/75.2 (CCB) and 139.1/80.3 (ACEI) for ARB, BB, CCB and ACE inhibitors respectively. Compared to ACE inhibitors, BP was significantly lower with ARB (P < 0.01). The proportion of subjects with a BP below 140/90 mmHg was 73% for ARB, 52% for BB, 68% for CCB and 47% for ACE with a statistical significance (P = 0.03) for ARB vs. ACEI and CCB vs. ACEI.ConclusionAmong subjects treated for hypertension who owned a BP self-measurement device, 50 to 66% had a controlled BP (depending on the threshold used). It is observed differences between antihypertensive efficacy of monotherapy with a larger number of patients controlled with ARB or CCB.     

Combination therapy with an angiotensin-converting enzyme inhibitor and a calcium channel blocker

More than 1 medication is required in many hypertensive patients to reach blood pressure (BP) goals, and initial treatment with 2 agents has been recommended for patients whose BP level is >20/10 mm Hg above target. Diuretics reduce BP levels and the incidence of target organ complications and together with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers, which are recommended in patients with comorbid cardiovascular disease, nephropathy, or diabetes, are effective antihypertensive combinations. Calcium channel blockers (CCBs) are also effective antihypertensive agents, and evidence suggests that a CCB/ACEI combination is well tolerated and also decreases the risk of cardiovascular and renal disease. Some evidence suggests that this combination may improve endothelial function more than either agent alone, and its use could potentially lead to better cardiovascular outcomes than a diuretic/ACEI or diuretic/ARB combination. The ongoing Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension (ACCOMPLISH) trial compares these 2 effective combinations (ie, an ACEI/diuretic and ACEI/CCB) as initial treatment for reducing cardiovascular morbidity and mortality in older high-risk hypertensive patients. The results of this trial, when reported, should help to clarify the relative benefits of these different therapies.     

Trends in blood pressure control in hypertensive patients with diabetes mellitus in Japan.

Hypertension is often accompanied by type 2 diabetes mellitus. Recently, the American Diabetes Association (ADA) published guidelines on the treatment of hypertension in adult patients with diabetes mellitus. However, the views of general physicians on how to control blood pressure (BP) in diabetic patients and the impact of the ADA guidelines in Japan are still not known. We conducted an internet survey in May 2002: Questionnaires were e-mailed to a total of 3,616 medical doctors, of whom 441 (12.2%) properly responded. About half of the respondents (48.3%) had already read the ADA guidelines. Before being given an outline of the guidelines, the respondents' average BP level for starting medication was 152/94 mmHg, and the BP goal 133/83 mmHg; after reading the outline, these values were 149/92 and 132/82 mmHg, respectively. The goal BP decreased more after reading the guidelines in doctors who had not previously read the ADA guidelines than in those who had already read. After being given an outline of the ADA guidelines, 40.3% of respondents reported that they would select, as a first-line agent, an angiotensin II receptor antagonist (ARB), 35.6% an angiotensin-converting enzyme inhibitor (ACEI), and 18.6% a calcium channel blocker (CCB); as a second-line medication, 39.7% of the respondents would select a CCB. Seventy percent of doctors reported having at least one patient receiving CCB monotherapy; after reading the guidelines, 41.5% of these doctors said they would continue CCB monotherapy, 36.6% said they would add an ACEI or ARB, and 29.7% planned to change to an ACEI or ARB. In conclusion, our data suggest the impact of the ADA guidelines on the target BP and the first choice of antihypertensive medication in diabetic patients. ARBs and ACEIs became first-line medications, and CCBs became second-line medications to achieve the BP goal and prevent organ damage.