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236: Progression of cerebral damage in patients with severe arterial hypertension on antihypertensive and statin therapy
Multiple Risk Factors in Cardiovascular Disease—Abstracts
236 PROGRESSION OF CEREBRAL DAMAGE IN PATIENTS WITH SEVERE ARTERIAL HYPERTENSION ON ANTIHYPERTENSIVE AND STATIN THERAPY G. Radchenko, Y.U. Sirenko. Institute of Cardiology, Kyiv, Ukraine In study were included 46 patients with severe arterial hypertension, who did not have the history of complications (stroke/TIA, myocardial infarction, heart or renal failure), but in some of them (43,3%) there were found zones of silent cerebral or white matter damage.It was found, that in spite of antihypertensive treatment 41,3 % of patients with severe hypertension had progression cerebral damage (onset of new and enlargement old zones of damage) during 1 year. Lowering of office, 24-hour and daytime BP were the same in patients with and without brain damage progression, but nighttime BP was significantly higher in patients with progression of damage. The level of BP decreasing did not correlate with brain damage progression. The main reason of it was not achieving of target blood pressure in observed group. The main risk factors of progression of damage were age > 59 years, impairing of left ventricular systolic function (ejection fraction <56 %), previous diagnosed brain damage, variability of night-time systolic BP < 11,5 mm Hg – increasing of risk in 3,7; 9,6; 6,9 and 4,9 times respectively.Patients with brain damage progression were characterized by impairing of day-night blood pressure changes (more of them became non-dippers) and increasing of percentage of patients with carotid atherosclerotic plaques. We did not find the superiority of any antihypertensive drugs in preventing of cerebral damage progression, but statins decreased brain damage progression on 70%, independently from their influence on total serum cholesterol level.
Florence, Florence, Italy, 2Research Institute for Public Health and Addiction, Zurich, Switzerland Objective: To measure the degree of ASA underutilization and to identify barriers to longterm compliance in post-MI patients using a newly developed physician questionnaire. Methods: In this pilot study, an online questionnaire was sent to a random sample of physicians in Italy and Germany during 2007. The questionnaire contained nine sections relating to patient profiles, contact frequency, attitudes towards secondary CVD prevention with ASA, and initiatives for improving long-term ASA compliance. Results: Completed questionnaires were received from 36% (n=543/1490) in Italy and 12% (n=343/2847) in Germany; the majority of responders were primary care physicians (Italy, 78%; Germany, 71%). Most of the responding physicians (79%) agreed that lifelong ASA therapy is indispensable in post-MI, with 76% agreeing on its proven effectiveness. Nearly all physicians (85%) prescribed ASA 100 mg, and the majority prescribed ASA alone (64%). However, 11% and 20% of ASA-treated patients were rated as ‘definitely non-compliant’ and having ‘instable compliance’, respectively. When asked about ways to improve compliance, the majority of physicians (>80%) rated shared decision making and improvement of ASA packs as effective measures. Conclusions: These preliminary results highlight important information regarding physician attitudes towards ASA therapy and they indicate that around one-third of patients have sub-optimal compliance. The questionnaire is suitable for measuring secondary CVD prevention strategies in post-MI, and will be used in the ACT study, which is being conducted across 20 countries. Funding: Bayer Schering Pharma
Funding: none 238 237 DEVELOPMENT OF A QUESTIONNAIRE DESIGNED TO MEASURE ADHERENCE TO SECONDARY CVD PREVENTION STRATEGIES IN POST-MI PATIENTS: THE ACT PILOT STUDY A. Zaninelli1, D. Schwappach2. 1University of
S110
MULTIDISCIPLINARY SELF-MANAGEMENT OF RISK FACTORS FOR HEART FAILURE C. Smith. University of Kansas Medical Center, Kansas City, KS, USA Objective: Heart Failure (HF) discharge programs and home nursing follow-up reduce
236 PROGRESSION OF CEREBRAL DAMAGE IN PATIENTS WITH SEVERE ARTERIAL HYPERTENSION ON ANTIHYPERTENSIVE AND STATIN THERAPY G. Radchenko, Y.U. Sirenko. Institute of Cardiology, Kyiv, Ukraine In study were included 46 patients with severe arterial hypertension, who did not have the history of complications (stroke/TIA, myocardial infarction, heart or renal failure), but in some of them (43,3%) there were found zones of silent cerebral or white matter damage.It was found, that in spite of antihypertensive treatment 41,3 % of patients with severe hypertension had progression cerebral damage (onset of new and enlargement old zones of damage) during 1 year. Lowering of office, 24-hour and daytime BP were the same in patients with and without brain damage progression, but nighttime BP was significantly higher in patients with progression of damage. The level of BP decreasing did not correlate with brain damage progression. The main reason of it was not achieving of target blood pressure in observed group. The main risk factors of progression of damage were age > 59 years, impairing of left ventricular systolic function (ejection fraction <56 %), previous diagnosed brain damage, variability of night-time systolic BP < 11,5 mm Hg – increasing of risk in 3,7; 9,6; 6,9 and 4,9 times respectively.Patients with brain damage progression were characterized by impairing of day-night blood pressure changes (more of them became non-dippers) and increasing of percentage of patients with carotid atherosclerotic plaques. We did not find the superiority of any antihypertensive drugs in preventing of cerebral damage progression, but statins decreased brain damage progression on 70%, independently from their influence on total serum cholesterol level.
Florence, Florence, Italy, 2Research Institute for Public Health and Addiction, Zurich, Switzerland Objective: To measure the degree of ASA underutilization and to identify barriers to longterm compliance in post-MI patients using a newly developed physician questionnaire. Methods: In this pilot study, an online questionnaire was sent to a random sample of physicians in Italy and Germany during 2007. The questionnaire contained nine sections relating to patient profiles, contact frequency, attitudes towards secondary CVD prevention with ASA, and initiatives for improving long-term ASA compliance. Results: Completed questionnaires were received from 36% (n=543/1490) in Italy and 12% (n=343/2847) in Germany; the majority of responders were primary care physicians (Italy, 78%; Germany, 71%). Most of the responding physicians (79%) agreed that lifelong ASA therapy is indispensable in post-MI, with 76% agreeing on its proven effectiveness. Nearly all physicians (85%) prescribed ASA 100 mg, and the majority prescribed ASA alone (64%). However, 11% and 20% of ASA-treated patients were rated as ‘definitely non-compliant’ and having ‘instable compliance’, respectively. When asked about ways to improve compliance, the majority of physicians (>80%) rated shared decision making and improvement of ASA packs as effective measures. Conclusions: These preliminary results highlight important information regarding physician attitudes towards ASA therapy and they indicate that around one-third of patients have sub-optimal compliance. The questionnaire is suitable for measuring secondary CVD prevention strategies in post-MI, and will be used in the ACT study, which is being conducted across 20 countries. Funding: Bayer Schering Pharma
Funding: none 238 237 DEVELOPMENT OF A QUESTIONNAIRE DESIGNED TO MEASURE ADHERENCE TO SECONDARY CVD PREVENTION STRATEGIES IN POST-MI PATIENTS: THE ACT PILOT STUDY A. Zaninelli1, D. Schwappach2. 1University of
S110
MULTIDISCIPLINARY SELF-MANAGEMENT OF RISK FACTORS FOR HEART FAILURE C. Smith. University of Kansas Medical Center, Kansas City, KS, USA Objective: Heart Failure (HF) discharge programs and home nursing follow-up reduce