233 research outputs found
Blood pressure and lipid goal attainment in the hypertensive population in the primary care setting in Spain
[Abstract] Although blood pressure (BP) control is crucial in hypertensive patients, clinical practice guidelines agree that the goal of treatment should be aimed at not only decreasing BP but reducing global cardiovascular risk. The aim of this cross-sectional study was to evaluate BP, low-density lipoprotein cholesterol (LDL-C), and composite control rates in a hypertensive population in a primary care setting in Spain. Good BP control was defined as <140/90 mm Hg (<130/80 mm Hg for diabetics).LDL-C control rate was established according to the third report of the National Cholestrol Education Program Adult Treatment Panel criteria. A total of 12,954 patients (49.9% women, aged 62.1±10.7 years) were included. BP was controlled in 24.8% of patients, LDL-C in 26% of patients and, when combined, in only 8.6%. The rates of control were significantly worse in high-risk subgroups, such as high-coronary-risk, diabetic, or metabolic syndrome patients. The BP and LDL-C control rates in the hypertensive population attended to daily in primary care settings in Spain are low
Cost of poor adherence to anti-hypertensive therapy in five European countries
The financial burden for EU health systems associated with cardiovascular disease (CV) has been estimated to be nearly €110 billion in 2006, corresponding to 10 % of total healthcare expenditure across EU or a mean €223 annual cost per capita. The main purpose of this study is to estimate the costs related to hypertension and the economic impact of increasing adherence to anti-hypertensive therapy in five European countries (Italy, Germany, France, Spain and England). A probabilistic prevalence-based decision tree model was developed to estimate the direct costs of CV related to hypertension (CV defined as: stroke, heart attack, heart failure) in five European countries. Our model considered adherence to hypertension treatment as a main driver of blood pressure (BP) control (BP < 140/90 mmHg). Relative risk of CV, based on controlled or uncontrolled BP group, was estimated from the Framingham Heart Study and national review data. Prevalence and cost data were estimated from national literature reviews. A national payer (NP) perspective for 10 years was considered. Probabilistic sensitivity analysis was performed in order to evaluate uncertainty around the results (given as 95 % confidence intervals). The model estimated a total of 8.6 million (1.4 in Italy, 3.3 in Germany, 1.2 in Spain, 1.8 in France and 0.9 in England) CV events related to hypertension over the 10-year time horizon. Increasing the adherence rate to anti-hypertensive therapy to 70 % (baseline value is different for each country) would lead to 82,235 fewer CV events (24,058 in Italy, 7,870 in Germany, 18,870 in Spain, 24,855 in France and 6,553 in England). From the NP perspective, the direct cost associated with hypertension was estimated to be €51.3 billion (8.1 in Italy, 17.1 in Germany, 12.2 in Spain, 8.8 in France and 5.0 in England). Increasing adherence to anti-hypertensive therapy to 70 % would save a total of €332 million (CI 95 %: €319-346 million) from the NPs perspective. This study is the first attempt to estimate the economic impact of non-adherence amongst patients with diagnosed hypertension in Europe, using data from five European countries (Italy, France, Germany, Spain and England). © 2014 Springer-Verlag Berlin Heidelberg
An international comparative study of blood pressure in populations of European vs. African descent
Background: The consistent finding of higher prevalence of hypertension in US blacks compared
to whites has led to speculation that African-origin populations are particularly susceptible to this
condition. Large surveys now provide new information on this issue.
Methods: Using a standardized analysis strategy we examined prevalence estimates for 8 white
and 3 black populations (N = 85,000 participants).
Results: The range in hypertension prevalence was from 27 to 55% for whites and 14 to 44% for
blacks.
Conclusions: These data demonstrate that not only is there a wide variation in hypertension
prevalence among both racial groups, the rates among blacks are not unusually high when viewed
internationally. These data suggest that the impact of environmental factors among both
populations may have been under-appreciated
Efficacy of a brief multifactorial adherence-based intervention on reducing the blood pressure of patients with poor adherence: protocol for a randomized clinical trial
<p>Abstract</p> <p>Background</p> <p>Lowering of blood pressure by antihypertensive drugs reduces the risks of cardiovascular events, stroke, and total mortality. However, poor adherence to antihypertensive medications reduces their effectiveness and increases the risk of adverse events. In terms of relative risk reduction, an improvement in medication adherence could be as effective as the development of a new drug.</p> <p>Methods/Design</p> <p>The proposed randomized controlled trial will include patients with a low adherence to medication and uncontrolled blood pressure. The intervention group will receive a multifactorial intervention during the first, third, and ninth months, to improve adherence. This intervention will include motivational interviews, pill reminders, family support, blood pressure self-recording, and simplification of the dosing regimen.</p> <p>Measurement</p> <p>The primary outcome is systolic blood pressure. The secondary outcomes are diastolic blood pressure, proportion of patients with adequately controlled blood pressure, and total cost.</p> <p>Discussion</p> <p>The trial will evaluate the impact of a multifactorial adherence intervention in routine clinical practice. Ethical approval was given by the Ethical Committee on Human Research of Balearic islands, Spain (approval number IB 969/08 PI).</p> <p>Trial registration</p> <p>Current controlled trials ISRCTN21229328</p
Methodologies used to estimate tobacco-attributable mortality: a review
<p>Abstract</p> <p>Background</p> <p>One of the most important measures for ascertaining the impact of tobacco on a population is the estimation of the mortality attributable to its use. To measure this, a number of indirect methods of quantification are available, yet there is no consensus as to which furnishes the best information. This study sought to provide a critical overview of the different methods of attribution of mortality due to tobacco consumption.</p> <p>Method</p> <p>A search was made in the Medline database until March 2005 in order to obtain papers that addressed the methodology employed for attributing mortality to tobacco use.</p> <p>Results</p> <p>Of the total of 7 methods obtained, the most widely used were the prevalence methods, followed by the approach proposed by Peto et al, with the remainder being used in a minority of studies.</p> <p>Conclusion</p> <p>Different methodologies are used to estimate tobacco attributable mortality, but their methodological foundations are quite similar in all. Mainly, they are based on the calculation of proportional attributable fractions. All methods show limitations of one type or another, sometimes common to all methods and sometimes specific.</p
Mortality attributable to excess adiposity in England and Wales in 2003 and 2015: explorations with a spreadsheet implementation of the Comparative Risk Assessment methodology
Our aim was to estimate the burden of fatal disease attributable to excess adiposity in England and Wales in 2003 and 2015 and to explore the sensitivity of the estimates to the assumptions and methods used
Low Rates of Both Lipid-Lowering Therapy Use and Achievement of Low-Density Lipoprotein Cholesterol Targets in Individuals at High-Risk for Cardiovascular Disease across Europe
Aims
To analyse the treatment and control of dyslipidaemia in patients at high and very high cardiovascular
risk being treated for the primary prevention of cardiovascular disease (CVD) in
Europe.
Methods and Results
Data were assessed from the European Study on Cardiovascular Risk Prevention and Management
in Usual Daily Practice (EURIKA, ClinicalTrials.gov identifier: NCT00882336),
which included a randomly sampled population of primary CVD prevention patients from 12
European countries (n = 7641). Patients’ 10-year risk of CVD-related mortality was calculated
using the Systematic Coronary Risk Evaluation (SCORE) algorithm, identifying 5019
patients at high cardiovascular risk (SCORE 5% and/or receiving lipid-lowering therapy),
and 2970 patients at very high cardiovascular risk (SCORE 10% or with diabetes
mellitus). Among high-risk individuals, 65.3% were receiving lipid-lowering therapy, and
61.3% of treated patients had uncontrolled low-density lipoprotein cholesterol (LDL-C)
levels ( 2.5 mmol/L). For very-high-risk patients (uncontrolled LDL-C levels defined as
1.8 mmol/L) these figures were 49.5% and 82.9%, respectively. Excess 10-year risk of
CVD-related mortality (according to SCORE) attributable to lack of control of dyslipidaemia
was estimated to be 0.72%and 1.61% among high-risk and very-high-risk patients, respectively.
Among high-risk individuals with uncontrolled LDL-C levels, only 8.7% were receiving
a high-intensity statin (atorvastatin 40 mg/day or rosuvastatin 20 mg/day). Among veryhigh-
risk patients, this figure was 8.4%.
Conclusions
There is a considerable opportunity for improvement in rates of lipid-lowering therapy use
and achievement of lipid-level targets in high-risk and very-high-risk patients being treated
for primary CVD prevention in EuropeWriting support was provided by Oxford
PharmaGenesis Ltd, Oxford, UK, and was
funded by AstraZenec
Therapeutic implications of selecting the SCORE (European) versus the D'AGOSTINO (American) risk charts for cardiovascular risk assessment in hypertensive patients
Background: No comparisons have been made of scales estimating cardiovascular mortality and overall cardiovascular morbidity and mortality. The study objectives were to assess the agreement between the Framingham-D'Agostino cardiovascular risk (CVR) scale and the chart currently recommended in Europe (SCORE) with regard to identification of patients with high CVR, and to describe the discrepancies between them and the attendant implications for the treatment of hypertension and hyperlipidaemia. Methods: A total of 474 hypertensive patients aged 40-65 years monitored in primary care were enrolled into the study. CVR was assessed using the Framingham-D'Agostino scale, which estimates the overall cardiovascular morbidity and mortality risk, and the SCORE chart, which estimates the cardiovascular mortality risk. Cardiovascular risk was considered to be high for values ≥ 20% and ≥ 5% according to the Framingham-D'Agostino and SCORE charts respectively. Kappa statistics was estimated for agreement in classification of patients with high CVR. The therapeutic recommendations in the 2007 European Guidelines on Cardiovascular Disease Prevention were followed. Results
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