PubMed · 243536
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G W Ward. 1977. Hypertension.. https://pubmed.ncbi.nlm.nih.gov/243536/
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Failure of physicians to adhere to hypertension guidelines may partly account for the failure to achieve blood pressure (BP) goals in clinical practice. The aim of this trial is a comprehensive description of the approach of physicians in the management of high BP among primary care patients. It will primarily assess what are the Reasons for not Intensifying an Antihypertensive Treatment (RIAT), when predefined individual BP goals are not achieved. Open intervention survey was conducted in 17 countries in Latin America, Eastern Europe, Africa and Asia in family practices, government and private clinics. The registry is based on a three-step epidemiological design. Step one shall identify guidelines and recommendations taken as reference in each country for the management of hypertension. Step two will assess the variance between individual targets defined by physicians in their practice compared to guidelines and recommendations. Step three is a prospective registry where physicians collect patient data at baseline; determine individual target BP values. Several follow-up visits are proposed to monitor achievement of these targets. Step three of RIAT aims at providing responses to several key objectives. Recruitment is under way aiming at enrolling 33,000 patients. To identify, what is the BP targeted according to the risk factor profile and what are the reasons for not modifying an antihypertensive treatment when BP goals are not reached, and to analyse the type of antihypertensive drugs prescribed according to compelling indications and to assess the percentage of patients reaching target figures.
BACKGROUND AND OBJECTIVE: In 2003 the German Health Insurance (DKV: Deutsche Krankenversicherung) initiated a "Health Program Hypertension" for its insured persons with the aim of motivating patients to adopt the accepted general measures for blood pressure reduction and to self-monitor their blood pressure. PATIENTS AND METHODS: Participation in the program was voluntary and without charge. The interventional measures included regular contact by phone with trained medical personnel, personal consultations targeting general measures and self measurement of blood pressure. Each patient was given training material and a blood pressure monitor, and a risk profile was made for each patient. Regular reports were given to the patients and their physicians. RESULTS: The data of the first 1373 hypertensives who have been in the continuing program were analysed. The patients" average age was 61+/-9.9 years, 81% males. 94% of the participants reported taking antihypertensive medication. Initially 615 patients (44.8%) had an increased blood pressure on self-measurement ((3)135/85 mmHg). The blood pressure of these patients was significantly reduced, after an average of 16.3 months, from 145/91+/-12.7 mmHg to 135/84 +/-12.8 mmHg (p<0.001). A statistically significant weight reduction was achieved in 308 patients (22.4%) with a body mass index (BMI) of (3) 30 kg/m2, from 33.4 to 32.9 kg/m2 (p<0.001). Lipid metabolism, important life-style parameters (food and physical activity) and a knowledge of important laboratory tests (glucose and creatinine) also changed positively. Antihypertensive medication remained nearly unchanged during the period of observation. CONCLUSIONS: The patients participating in the Health Program Hypertension were already reasonably well controlled. The program achieved further lasting improvement of blood pressure. In addition the participants were motivated to adopt a more health-conscious life style. Training and care of the patients by a medical services centre would seem sensible and successful. But it remains a challenge, especially to reach poorly controlled hypertensives and to motivate them to an active participation in the program.
Endothelial cation channel are important regulators of vascular tone by modulating intracellular Ca(2+)-signaling and thus adequate synthesis of vasodilating factors. The overall importance of these ion channels suggests that they may represent novel pharmacotherapeutic targets in addition to the well-known voltage-gated calcium channels in vascular smooth muscle. In this short overview we summarize the current knowledge about endothelial ion channels and their roles for endothelium-dependent vasodilatation. Furthermore, we perspectively discuss the usefulness of specific openers of endothelial Ca(2+)-activated K(+)-channels and TRPV-channels as novel antihypertensive drugs.