Pharmacist interventions to enhance patient adherence to self-administered antihypertensive medication: a systematic review

Pharmacist interventions to enhance patient adherence to self-administered antihypertensive medication: a systematic review

S36 Abstracts plaque biology. The purpose of the present study is to evaluate additive effects of telmisartan (ARB) and Rosuvastatin (HMG-CoA reduct...

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Abstracts

plaque biology. The purpose of the present study is to evaluate additive effects of telmisartan (ARB) and Rosuvastatin (HMG-CoA reductase inhibitor) to endothelial function, insulin sensitivity and arterial stiffness in essential hypertension. Subjectives and methods: Thirty-nine patients with essential hypertension were to receive telmisartan, which was administered at doses of 80 mg once daily using an open-labeled, prospective protocol for 8 weeks. And then twenty of them were to continue telmisartan therapy alone and nineteen were to receive rosuvastatin at doses of 30 mg once daily added to telmisartan. The patients were examined at baseline, 8 weeks, 16 weeks to assess changes of flow mediated-vasodilation (FMD), QUICKI (quantitative insulin-sensitivity check index), HOMA (homeostasis model assessment), adiponection and pulse wave velocity (PWV). Results: Telmisartan therapy improved FMD (from 7.6 ± 3.5 to 9.0 ± 2.8%, p < 0.01) and PWV (Rt 17.3 ± 3.1 to 15.9 ± 2.6, Lt. 17.5 ± 2.8 to 16.1 ± 2.6 m/s, p < 0.01) at 8 weeks. But, it was not changed in QUICKI, HOMA level, and plasma adiponectin (p = NS, respectively). At 16 weeks, FMD and PWV of both group didn't increase (p = NS) compared to 8 weeks' result. Conclusion: These results suggest that telmisartan is effective at improving endothelial function and arterial stiffness in hypertensive patients in Korea. But adding rosuvastatin to telmisartan had little additive effect on that.

Objective: To explore the relationship between blood pressure and carotid haemodynamics in normotensive carotid stenosis patients by color duplex ultrasonography. Methods: The blood pressure and carotid haemodynamics indexes of 80 mortotensive carotid stenosis patients were checked, including systolic blood pressure (SBP), diastolic blood pressure (DBP) and the heamodynamics parameters (peak systolic velocity, PSV; end diastolic velocity, EDV; pulsatility indexes, PI; resistant indexes, RI; and inside diameters, D, respectively) of bilateral carotid arteries (common carotid artery, CCA; internal carotid artery, ICA; vertebral artery, VA, respectively). Results: 1) The stenosis grades would accelerate blood velocity of the stenosis internal carotid artery. 2) The vertebral artery blood flow velocity were faster in SBP of 90 to 120 mm Hg and DBP of 60 to 79 mm Hg, while the blood flow resistance was smaller in the same blood pressure level. Then the vertebral artery blood flow velocity would go down and the blood flow resistance would raise, with the increase of blood pressure especially SBP of >120 mm Hg, DBP of ≥80 mm Hg. Conclusions: Lowering blood pressure could help promote the carotid blood flow velocity and increase cerebral blood flow and SBP of 90 to 120 mm Hg and DBP of 60 to 79 mm Hg may help to maintain the better cerebral haemodynamics. doi:10.1016/j.ijcard.2009.09.119

doi:10.1016/j.ijcard.2009.09.117 CT000296 The effect of anxiety depression on morning blood pressure surge and heart rate variability in patients with hypertension XIN-JUAN XU, HONG-YUN XING, YONG-ZHI WANG The First Affiliated Hospital of Xinjiang Medical University, China Department of Cardiovascular Medicine, The Fifth Affiliated Hospital of Xinjiang Medical University, China Objective: To investigate the effect anxiety depression on MBPS and heart rate variability (HRV) in patients with EH, MBPS and HRV. Methods: To evaluate in 106 EH patients, to divided into anxiety depression group (n = 52) and non-anxiety non-depression group (n = 54) according to anxiety depression. To compare related clinic information between anxiety depression group and non-anxiety nondepression group, Holter ECG monitoring, ambulatory blood pressure and MBPS. Results: (1) The 24 hours average blood pressure, the average blood pressure of daytime, the average blood pressure of night, the blood pressure of morning and MBPS in anxiety depression group are all higher than non-anxiety non-depression group (P <0.01), and then the blood pressure of morning improve obviously (P <0.01), MBPS(+) in anxiety depression group are higher than non-anxiety non-depression group (67.3% to 31.5%, P < 0.01).(2) The HRV index (SDNN, SDANN, RMSSD, PNN50) in anxiety depression group are lower than non-anxiety nondepression group (P< 0.01). (3) The logistic regression analysis indicate that the dangerous MBPS(+) occurred in EH patients are related with age increasing ,with anxiety depression and SDNN decreasing (OR are 2.524, 2.699, 3.867, P <0.05). Conclusion: Anxiety depression increase the MBPS(+) in EH patients related with the damage of autonomic nerves. doi:10.1016/j.ijcard.2009.09.118 CT000297 The relationship between blood pressure and carotid haemodynamics in normotensive carotid stenosis patients XIN-JUAN XU, RONG REN, KAI-PING FAN Department of Hypertension, The First Affiliated Hospital of XinJiang Medical University, China

CT000326 Pharmacist interventions to enhance patient adherence to self-administered antihypertensive medication: a systematic review M. MORGADOa,b, S. MORGADOb, L. CASTANHEIRAa, I. VERDEa, M. CASTELO-BRANCOa,c a Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal b Pharmacy Department, Hospital Centre of Cova da Beira E.P.E., Covilhã, Portugal c Emergency Department, Hospital Centre of Cova da Beira E.P.E., Covilhã, Portugal Objective: Some studies have assessed pharmacist interventions in hypertensive patients in order to enhance adherence to medication. Our aim is to review published data on pharmacist interventions targeting antihypertensive medication adherence and reporting blood pressure (BP) outcomes in adults with high BP. Design and methods: A systematic literature review was conducted. A search in MEDLINE, The Cochrane Library and the ISI Web of Knowledge was performed from January 1999 to May 2009, to identify relevant articles of pharmacist interventions intended to improve adherence to antihypertensive medications. We also hand searched bibliographies in articles on patient adherence to identify relevant articles. Studies were included if they reported a pharmacist intervention to improve adherence with antihypertensive drugs, with adherence to medication and BP control as outcomes. Two authors selected studies and extracted the data independently. Results: We included 15 studies testing 18 different interventions and containing data on 3,280 patients. The duration of follow-up ranged from 2 weeks to 12 months. Studies were too heterogeneous in terms of the interventions and methods used to measure adherence to warrant meta-analysis. Although 83% of the interventions reported statistically significant improvements in treatment outcomes, only 50% of the interventions tested were associated with significant increases in medication adherence, with a relative increase in adherence of 12.0% to 26.4%. Almost all the interventions that were effective in increasing adherence to BP-lowering medication were complex, including combinations of simplifying doses regimes, educational strategies directed to the patient, reminders, BP self-monitoring, scheduling

Abstracts

more frequent follow-up appointments, and other forms of additional supervision. Conclusions: Pharmacist intervention can modify factors affecting adherence, improve adherence and reduce BP levels in patients treated with antihypertensive agents. Even in some interventions that did not improve medication adherence, a statistically significant improvement in BP was reported, reinforcing the pharmacist role on improving the health system of care. doi:10.1016/j.ijcard.2009.09.120 CT000341 The relationship between postprandial serum triglyceride levels and artery elasticity on hypertension W. PENG, H.L. LIN No.2 People Hospital of Dalian, China Objective: To explain the change of postprandial serum triglyceride levels after a single high-fat meal (800 calories 50 g fat), and to investigate the relationship between postprandial serum triglyceride levels and artery elasticity. Methods: 34 patients with essential hypertension and 34 healthy controls were studied .The concentration of triglyceride, total cholesterol, LDL cholesterol, and HDL cholesterol in fasting serum and at 4 h after a single high-fat meal were measured. There were 13 patients with essential hypertension and 16 healthy controls which had postprandial hypertriglyceridemia (TG > 1.7 mmol/L), others had normal postprandial serum triglyceride levels .Small and large artery elasticity was assessed in the brachial artery by the HDI/ Pulse wave CR-2000 Research Cardiovascular Profiling Systems before and after 4 h of high-fat meal. Result: No significant difference in fasting lipid levels among two subjects was found. Compared to normal subjects the patients with hypertension had higher serum triglyceride levels at 4 h (p < 0.05), the postprandial small artery elasticity impaired significantly after a high-fat meal in postprandial hypertriglyceridemia groups (p < 0.05) both patients and controls. There is no obvious change between two groups of subjects on large artery elasticity with postprandial. The postprandial artery elasticity was more serious in essential hypertension patients with postprandial hypertriglyceridemia. Conclusions: The 4 hour serum triglyceride level was correlated with the degree of impairment of postprandial artery elasticity. An obvious and persistent postprandial hypertriglyceridemia in patients induced significantly impairment of postprandial artery elasticity. doi:10.1016/j.ijcard.2009.09.121

CT000508 Total flavones of Hippophae rhamnoides L. for essential hypertension: a systematic review of randomized controlled trials XINJUN ZHANG, BINBIN CHANG West China Hospital, Sichuan University, China Objective: To assess the efficacy, safety and economy of total flavones of Hippophae rhamnoides L. (TFH) on treatment of essential hypertension. Methods: We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2009), MEDLINE (1950 to June 2009), EMbase (1980 to June 2009), CNKI (1995 to June 2009), VIP (1989 to June 2009). Then we screened the retrieved studies according to predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed Meta-analyses by using The Cochrane Collaboration'RevMan 5.0 software. Results: Only seven trials with 644 patients were included in the systematic review. Meta-analyses showed that TFH had the similar effects to calcium-channel blocker(CCB) [WMD 2.34,95%CI

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−0.86 to 5.53] and angiotensin-converting enzyme inhibitor(ACEI) (WMD −0.01,95%CI −0.97 to 0.95) in decreasing diastolic blood pressure; but TFH plus CCB was superior to CCB in decreasing systolic blood pressure (WMD −31.65, 95%CI −34.70 to −28.60) and diastolic blood pressure (WMD −17.11, 95%CI −20.17 to −14.05). TFH was inferior to ACEI in improving left ventricular posterior wall thickness (LVPWT) [WMD −1.27, 95%CI −1.72 to −0.82] and interventricular septal thickness (IVST[WMD −1.97, 95%CI −2.40 to −1.55]; TFH had the similar effect to ACEI in E/A [WMD −0.02, 95%CI −0.08 to 0.04]; but TFH plus CCB was more effective in improving LVPWT (WMD −2.36, 95%CI −2.99 to −1.73) and IVST (WMD −2.93, 95%CI −3.44 to −2.42). Moreover, TFH was similar to ACEI in regulating blood β2-microglobulin (β2-MG)[WMD −0.57, 95%CI −1.18 to 0.04], creatinine clearance rate (Ccr) [WMD −6.97, 95%CI −3.42 to 17.36], urinary albumin value in 24 h [WMD −2.59, 95%CI −8.97 to 3.76]. Conclusions: The evidence currently available shows that TFH may decrease systolic blood pressure, diastolic blood pressure. Moreover, TFH have less adverse effects and less economy load, and protect the target organs. doi:10.1016/j.ijcard.2009.09.122

CT000541 Benefits of nifedipine GITS in stable coronary artery disease: further analysis of the “ACTION” database P.A. MEREDITHa, H.L. ELLIOTTb Western Infirmary, Glasgow, United Kingdom b University of Strathclyde, Glasgow, United Kingdom a

The placebo-controlled ACTION trial examined the effects of Nifedipine GITS on clinical outcomes in patients with stable symptomatic coronary artery disease (CAD). A retrospective further analysis of the database from ACTION evaluated the potential benefits of nifedipine GITS in combination with other treatments. Analyses were performed on an intention-to-treat basis. Treatment groups were compared by the log-rank test without adjustment for covariates. Hazard ratios with 95% CIs were obtained using Cox proportional hazards models with treatment allocation as the only covariate. Of 7,665 randomised patients 1,732 (22.6%) were receiving RAS blockade (ACE inhibitor or ARB) at baseline and 857 were randomised to nifedipine GITS and 875 to placebo. Nifedipine significantly reduced a number of endpoints: these included any CV event (− 20%; p < 0.05), the composite of death, any CV event and revascularisation (− 16%; p < 0.05) and coronary angiography (− 22%; p < 0.01). There were non-significant reductions in the primary composite end-points for efficacy (− 14%) and safety (− 7%). These benefits were achieved with relatively small differences in systolic BP (3.2 mm Hg) and diastolic BP (2.3 mm Hg). Further analyses demonstrated a significant outcome benefit in patients treated with nifedipine GITS in the absence of RAS blockade compared to patients receiving RAS blockade and placebo. Since the publication of the HOPE trial there has been a widespread perception that treatment with ACE inhibitor drugs are selectively beneficial in the treatment of patients with established CAD and that these benefits are not attributable to BP lowering alone. While these findings must be the interpreted cautiously, the retrospective analyses in well matched groups of patients, show that in the treatment of symptomatic CAD, additional prognostic benefit can be derived from nifedipine GITS even in patients receiving RAS blockade at baseline. While these findings must be the interpreted cautiously, the treatment groups in both analyses were well matched in their demographic features and active treatments at baseline. doi:10.1016/j.ijcard.2009.09.123