Introduction: Hypertension: meeting therapeutic challenges, providing effective management
Article Abstract:
In October 1990, physicians and medical researchers assembled in Laguna Niguel, California for a symposium on the treatment of high blood pressure (hypertension). Hypertension is an important risk factor for heart failure, stroke, and kidney failure. The successful treatment and prevention of the complications of hypertension involves many factors. An understanding of the physiology of high blood pressure is important, but not in itself sufficient. Participants in the symposium heard discussions not only of the physiology of high blood pressure, but on factors affecting patient compliance, economic and social factors influencing successful treatment, and strategies to minimize unpleasant side effects. Among the diseases treated by practicing physicians, hypertension is unusual in that it has no symptoms. Unfortunately, the drugs used to treat high blood pressure have side effects. Since the patient feels well, getting him to take medication that may make him feel worse is difficult. It is estimated that only half of patients beginning drug therapy for hypertension continue their therapy past the first few months. This problem of compliance may be worse among the poor and among people who are less fluent in English. Compliance is also a problem among the elderly, who often must take many different medications at the same time for a variety of ailments. The use of a transdermal patch may significantly help to improve patient compliance. The transdermal patch looks like a bandage and is stuck to the skin, often on the shoulder or back. Medication contained in the patch seeps into the skin, where it enters the blood and circulates through the body. The transdermal patch improves patient compliance and provides an additional option for physicians working out an individual program of treatment for a hypertensive patient. Some researchers at the Symposium presented data that indicate that efforts to improve the compliance of patients taking hypertension medication not only makes good health sense, but it also makes economic sense as well. Improved compliance reduces necessary health care expenditures in the long run. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Ambulatory blood pressure monitoring in the evaluation of antihypertensive treatment
Article Abstract:
Ambulatory blood pressure monitoring, or recording blood pressure over 24-hour periods during which the patient may be walking around, is a valid method for evaluating drug therapy for hypertension, or abnormally high blood pressure. It allows the physician to determine whether the patient's blood pressure is reduced during daily activities and to exclude the possibility that the blood pressure reduction was a hypotensive event, or episode of abnormally low blood pressure. However, the cost of this approach makes it impractical for clinical use, except in cases of very low or very high blood pressure which cannot be detected by cuff blood pressure measurements. The influence of this method on the outcome of the disease is not known. However, ambulatory blood pressure measurement has been useful in preliminary studies evaluating the effects of new antihypertensive agents. Ambulatory blood pressure values are more reproducible than cuff blood pressure measurements, reducing the number of patients required to demonstrate an antihypertensive effect in a preliminary study. These blood pressure values are affected little by placebo influences (blood pressures of patients who are not receiving the antihypertensive drug) and this simplifies the study design. Finally, the results provide information on the duration of the effects of the antihypertensive drug. The technical problems associated with ambulatory blood pressure monitoring are described. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1989
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Utility of a transdermal delivery system for antihypertensive therapy: part 1
Article Abstract:
High blood pressure (hypertension) is a contributing factor in the development of many cases of heart disease, stroke, and kidney failure. However, since hypertension has no symptoms itself, it is difficult to convince patients of the importance of taking antihypertensive medication according to the physician's prescription. A study was undertaken of Medicaid records in the state of Florida to evaluate the relationship between the dosage form of antihypertensive medication and the likelihood of compliance. The same data may also be used to compare patient compliance with the frequency of complications of hypertension. Medicaid reimburses patients for prescriptions, which made it possible to determine the Medication Possession Ratio (MPR) for the patients. (If the amount of prescription refills during the course of a year do not equal the amount prescribed, then the patient cannot be complying with instructions.) When the data were analyzed, it was found that patients using the clonidine transdermal patch had a significantly higher MPR than did other patients. This was especially true when the transdermal patch was part of a regimen involving several different antihypertensive drugs. These same patients required significantly fewer physician visits or laboratory and hospital services, suggesting that measurable health benefits had accrued from better patient compliance. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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