Blood pressure, controlling, effectiveness studies

Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek HW et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of diet in Renal Disease Study Group. N Engl J Med 1994 330 877-84. 

Gerber P, Liibben G, Heusler S, Dodo A. Effects of pioglitazone on metabolic control and blood pressure a randomized study in patients with type 2 diabetes mellitus. Curr Med Res Opin 2003 6 532-9. 

Mianserin has alpha-adrenoceptor activity and so might interact with clonidine (17). In healthy volunteers, pretreatment with mianserin 60 mg/day for 3 days did not modify the hypotensive effects of a single 300 mg dose of clonidine. In 11 patients with essential hypertension, the addition of mianserin 60 mg/day (in divided doses) for 2 weeks did not reduce the hypotensive effect of clonidine. The results of this study appear to have justified the authors conclusion that adding mianserin to treatment with clonidine will not result in loss of blood pressure control. 

In addition to evidence of regional variahon, healfh services research had demonstrated decreased rates of adherence fo accepted evidence-based therapeutic guidelines. Despite widely known professional guidelines (i.e., sixfh report of the Joint National Committee, JNC-VI), medical consensus on the health benefits of blood pressure confrol, and availability of effective mediations, blood pressure is poorly controlled in the U.S. Data from a nahonal research study found fhaf only 68% of pafienfs with hypertension are aware of fheir condition, and of those treated, only 27% have their blood pressures controlled. 

About 84% of the patients in the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan Study (RENAAL) required diuretic therapy to effect blood pressure control (31). Although not specifically reported, a similarly high proportion of patients were likely to have required diuretic therapy to reach the target blood pressure in the Irbesartan Diabetic Nephropathy Trial (IDNT) (32). These studies remind us once again of the importance of targeting volume control in order to reduce blood pressure in patients with chronic renal insufficiency. 

A meta-analysis of the effect of venlafaxine on blood pressure in patients studied in randomized placebo-controlled trials of venlafaxine, imipramine, and placebo showed that at the end of the acute phase (6 weeks) the incidence of a sustained rise in supine diastolic blood pressure (over 90 mmHg) was significantly higher in both active treatment groups venlafaxine 4.8% (135/2817), imipramine 4.7% (15/319), and placebo 2.1% (13/605) (8). The effect of venlafaxine in causing a rise in diastohc blood pressure appeared to be dose related, with an incidence of 1.7% in patients taking under 100 mg/day and 9.1% in those taking over 300 mg/day. 

Some of the earliest published reports on the effects of provision of pharmaceutical care provided insight into the effects of a pharmacy program in the care of patients with hypertension. In an early study by McKenney and colleagues, the effects of clinical pharmacy services in a group of hypertensive patients were described. Those patients who received pharmacy services in addition to standard care by their physician demonstrated an improvement in self-knowledge of their disease state, improved compliance, and better blood pressure control. Subsequent investigations have demonstrated a positive effect of pharmacy services on cost and quality of life in patients treated for hypertension. 

Lewis JB, Berl T, Bain RR et al. Effect of intensive blood pressure control on the course of type 1 diabetic nephropathy. Collaborative Study Group. Am J Kidney Dis 1999 34 809-817. 

Cost effectiveness analysis of improved blood pressure control in hypertensive patients with type 2 diabetes UKPDS 40. UK Prospective Diabetes Study Group. BMJ 1998 317 720-726. 

Such results indicate that in the present state of development of antihypertensive drugs any new compound, which in itself may not be sufficiently potent to be relied upon for adequate blood pressure control, may still be clinically useful if its mode of action is different from previously known agents and it does not cause disturbing or dangerous side effects. Such new agents may be useful in combination with other drugs, as shown in the Veterans Administration Cooperative Study. 

Because of the potential for ANF to be involved in blood pressure control, several investigators have studied its effects on the cardiovascular system of normal and hypertensive animals. In anesthetized normotensive and spontaneously hypertensive rats, atrial extract decreased arterial blood pressure in association with a decrease in both total peripheral resistance and cardiac contractility.il Also, a negative chronotropic effect has been reported in rats.H Dahl salt-sensitive rats appear to have greater amounts of ANF in their atria, but are hyporesponsive when exogenous material is injected.90 Results from this study also suggest an increase in renal papillary plasma flow and a washout of the medullary osmotic gradient, factors which could contribute significantly to the associated natriuresis and diuresis. Increased medullary and inner cortical blood flow also were reported in normotensive rats.118... 

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