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Blood pressure lowering for the prevention of stroke recurrence
S28
Abstracts
0282 Blood pressure lowering for the prevention of stroke recurrence ZENGWU WANGa, ZUO CHENa, TOM RICHARTb, JAN STAESSENb, LISHENG LIUa a The National Center of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China b Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium Objective: To investigate the effects of antihypertensive drug treatment on recurrent stroke in patients with a previous history of cerebrovascular disease. Methods: Original research papers published between 2000 and 2009, which focused on prevention of stroke recurrence by lowering blood pressure, were searched through PubMed database. The qualified data were processed with a meta-analysis. Data from trials that used a diuretic as opposed to a renin system inhibitors as the mainstay of active treatment were compared for subgroup analyses. Results: Ten randomized controlled trials were eligible for analysis, including 38,227 patients together. The pooled odds ratio for the prevention was 0.78 (95% confidence interval (CI), 0.68 to 0.90; P=0.007), 0.63 (CI, 0.54 to 0.73; Pb 0.0001) for trials involving a diuretic as a component of experimental therapy, and 0.93 (CI, 0.87 to 1.01; P=0.086) in the trials in which the mainstay of treatment consisted of inhibition of the renin system. The P-value for heterogeneity between studies involving diuretics as compared with renin system inhibitors was less than 0.0001. There was also heterogeneity in the odds ratios among all trials (P b 0.0001). The blood pressure reduction averaged 5.1/2.5 mmHg of systolic/diastolic in all studies, 8.5/3.6 mmHg in the trials of diuretics, 4.0 /2.1 mmHg in the studies of renin system inhibitors. The correlation between the odds of stroke recurrence and the reduction in systolic blood pressure approached significance. Conclusions: Blood pressure lowering reduced the risk of recurrent stroke significantly. doi:10.1016/j.ijcard.2011.08.555 0283 Hypertension control in communities (HCC): Analysis of antihypertensive drug regimen in baseline ZENGWU WANGa, XIN WANGa, XIAN LIa, WEN WANGa, WEIWEI CHENa, MANLU ZHUa, SHENGSHOU HUa, ZHENGLONG LEIb, LINGZHI KONGb, LISHENG LIUa a The National Center of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China b Bureau of Disease Control, Ministry of Health of China, Beijing, China Objective: The project of Hypertension Control in Communities (HCC) aimed to determine the effect of community-based standardized management on control of hypertension. Analyzing the current pattern of antihypertensive drug regimen in baseline was helpful for focusing on the training key. Methods: The protocol of communitybased standardized hypertension management was developed by an expert board being oriented by guidelines. Community health service centers across China were selected to implement the protocol. After being trained with the protocol, the grass-roots doctors from selected centers were asked to manage hypertensives in their communities according to the protocol. Patients who were serviced by the selected centers and with diagnosed hypertension were recruited. Data were collected by using questionnaire. Results: By the end of 2010, the program contained 255,168 patients with eligible baseline data, 93,953 (36.8%) of them under treatment with 47.7% male were used for this analysis. In baseline, patients with diuretic, β-blocker, CCB, ACEI, ARB, α-blocker and compound pill were 7.8%, 10.3%, 37.0%, 18.2%, 4.0%, 0.1%,
46.7%, respectively. In total, 84.1% patients took single antihypertensive drug in which 47.0% with compound pill and 28.8% with CCB; 16.6% were under combination drug therapy, out of them, 13.0% with twodrug, 2.6% with three-drug or more drugs. The used two-drug combinations are “CCB + ACEI” (38.0%), “β-blocker + CCB” (24.1%), and three-drug combinations are “β-blocker + CCB + ACEI” (15.8%), “diuretic + CCB +ACEI” (13.3%). Only 22.5% patients under treatment were controlled (b140/90 mmHg). Conclusion: The baseline status of medicine usage of HCC patients was subject to no standard in this article. It showed standardized management was necessary for the medicine usage and further improvement of hypertension control. doi:10.1016/j.ijcard.2011.08.556 0284 Relationship between heart rate and blood pressure level among community hypertensive patients XIAN LI, ZENGWU WANG, XIN WANG, WEN WNAG, WEIWEI CHEN, MANLU ZHU The National Center of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China Objective: To understand the relationship between heart rate and blood pressure level among community hypertensive patients. Methods: The project of Hypertension Control in Communities aimed to determine the effect of community-based standardized management on control of hypertension. The protocol of community-based standardized hypertension management was developed by an expert board being oriented by guidelines. Community health service centers (CHSC) across China were selected to implement the protocol. Patients who were serviced by the selected CHSC and with diagnosed hypertension were recruited. Data were collected by using questionnaire. Results: By the end of 2010, the program contained 205,900 patients having eligible baseline data with mean age 61 and 49% male for this analysis. The mean levels of systolic/diastolic blood pressure (SBP/DBP) at baseline were 143.9± 16.7/87.8± 10.3 mmHg. Both the mean levels of SBP and DBP were increased with heart rate in men and women, whether they are under treatment or not (all P b 0.001). Patients with heart rate of 60–79 beats/min had the lowest blood pressure level and highest control rate than other heart rate intervals. Differences of heart rate were not significant among classes of drugs (P N 0.05) for patients with single-antihypertensive-drug regiment; and so were the differences among patients with single-β-blocker, combining β-blocker or other (P N 0.05). Multiple line regression showed that SBP/DBP increased 1.7/1.1 mmHg per 10 beats increasing of heart rate (both P b 0.0001) after adjusted gender and under treatment. Conclusion: Baseline data of HCC showed the control rate is relatively higher when heart rate is located in 60–79 beats/min. It implies controlling the heart rate is necessary along with antihypertensive treatment. doi:10.1016/j.ijcard.2011.08.557 0286 Fixed-dose combination for antihypertensive therapy in the Community Healthcare (FIX-CATCH Study): Baseline characteristics of patients XIN WANGa, ZENGWU WANGa, XUEYING DUANb, XIAOMEI WANGc, GUANG HAOa, MANLU ZHUa, WEN WANGa a The National Center of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China b Beijing Huilan Hospital, Beijing, China c Beijing Highland Med-Tech Development Co. Ltd, Beijing, China
Abstracts
0282 Blood pressure lowering for the prevention of stroke recurrence ZENGWU WANGa, ZUO CHENa, TOM RICHARTb, JAN STAESSENb, LISHENG LIUa a The National Center of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China b Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium Objective: To investigate the effects of antihypertensive drug treatment on recurrent stroke in patients with a previous history of cerebrovascular disease. Methods: Original research papers published between 2000 and 2009, which focused on prevention of stroke recurrence by lowering blood pressure, were searched through PubMed database. The qualified data were processed with a meta-analysis. Data from trials that used a diuretic as opposed to a renin system inhibitors as the mainstay of active treatment were compared for subgroup analyses. Results: Ten randomized controlled trials were eligible for analysis, including 38,227 patients together. The pooled odds ratio for the prevention was 0.78 (95% confidence interval (CI), 0.68 to 0.90; P=0.007), 0.63 (CI, 0.54 to 0.73; Pb 0.0001) for trials involving a diuretic as a component of experimental therapy, and 0.93 (CI, 0.87 to 1.01; P=0.086) in the trials in which the mainstay of treatment consisted of inhibition of the renin system. The P-value for heterogeneity between studies involving diuretics as compared with renin system inhibitors was less than 0.0001. There was also heterogeneity in the odds ratios among all trials (P b 0.0001). The blood pressure reduction averaged 5.1/2.5 mmHg of systolic/diastolic in all studies, 8.5/3.6 mmHg in the trials of diuretics, 4.0 /2.1 mmHg in the studies of renin system inhibitors. The correlation between the odds of stroke recurrence and the reduction in systolic blood pressure approached significance. Conclusions: Blood pressure lowering reduced the risk of recurrent stroke significantly. doi:10.1016/j.ijcard.2011.08.555 0283 Hypertension control in communities (HCC): Analysis of antihypertensive drug regimen in baseline ZENGWU WANGa, XIN WANGa, XIAN LIa, WEN WANGa, WEIWEI CHENa, MANLU ZHUa, SHENGSHOU HUa, ZHENGLONG LEIb, LINGZHI KONGb, LISHENG LIUa a The National Center of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China b Bureau of Disease Control, Ministry of Health of China, Beijing, China Objective: The project of Hypertension Control in Communities (HCC) aimed to determine the effect of community-based standardized management on control of hypertension. Analyzing the current pattern of antihypertensive drug regimen in baseline was helpful for focusing on the training key. Methods: The protocol of communitybased standardized hypertension management was developed by an expert board being oriented by guidelines. Community health service centers across China were selected to implement the protocol. After being trained with the protocol, the grass-roots doctors from selected centers were asked to manage hypertensives in their communities according to the protocol. Patients who were serviced by the selected centers and with diagnosed hypertension were recruited. Data were collected by using questionnaire. Results: By the end of 2010, the program contained 255,168 patients with eligible baseline data, 93,953 (36.8%) of them under treatment with 47.7% male were used for this analysis. In baseline, patients with diuretic, β-blocker, CCB, ACEI, ARB, α-blocker and compound pill were 7.8%, 10.3%, 37.0%, 18.2%, 4.0%, 0.1%,
46.7%, respectively. In total, 84.1% patients took single antihypertensive drug in which 47.0% with compound pill and 28.8% with CCB; 16.6% were under combination drug therapy, out of them, 13.0% with twodrug, 2.6% with three-drug or more drugs. The used two-drug combinations are “CCB + ACEI” (38.0%), “β-blocker + CCB” (24.1%), and three-drug combinations are “β-blocker + CCB + ACEI” (15.8%), “diuretic + CCB +ACEI” (13.3%). Only 22.5% patients under treatment were controlled (b140/90 mmHg). Conclusion: The baseline status of medicine usage of HCC patients was subject to no standard in this article. It showed standardized management was necessary for the medicine usage and further improvement of hypertension control. doi:10.1016/j.ijcard.2011.08.556 0284 Relationship between heart rate and blood pressure level among community hypertensive patients XIAN LI, ZENGWU WANG, XIN WANG, WEN WNAG, WEIWEI CHEN, MANLU ZHU The National Center of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China Objective: To understand the relationship between heart rate and blood pressure level among community hypertensive patients. Methods: The project of Hypertension Control in Communities aimed to determine the effect of community-based standardized management on control of hypertension. The protocol of community-based standardized hypertension management was developed by an expert board being oriented by guidelines. Community health service centers (CHSC) across China were selected to implement the protocol. Patients who were serviced by the selected CHSC and with diagnosed hypertension were recruited. Data were collected by using questionnaire. Results: By the end of 2010, the program contained 205,900 patients having eligible baseline data with mean age 61 and 49% male for this analysis. The mean levels of systolic/diastolic blood pressure (SBP/DBP) at baseline were 143.9± 16.7/87.8± 10.3 mmHg. Both the mean levels of SBP and DBP were increased with heart rate in men and women, whether they are under treatment or not (all P b 0.001). Patients with heart rate of 60–79 beats/min had the lowest blood pressure level and highest control rate than other heart rate intervals. Differences of heart rate were not significant among classes of drugs (P N 0.05) for patients with single-antihypertensive-drug regiment; and so were the differences among patients with single-β-blocker, combining β-blocker or other (P N 0.05). Multiple line regression showed that SBP/DBP increased 1.7/1.1 mmHg per 10 beats increasing of heart rate (both P b 0.0001) after adjusted gender and under treatment. Conclusion: Baseline data of HCC showed the control rate is relatively higher when heart rate is located in 60–79 beats/min. It implies controlling the heart rate is necessary along with antihypertensive treatment. doi:10.1016/j.ijcard.2011.08.557 0286 Fixed-dose combination for antihypertensive therapy in the Community Healthcare (FIX-CATCH Study): Baseline characteristics of patients XIN WANGa, ZENGWU WANGa, XUEYING DUANb, XIAOMEI WANGc, GUANG HAOa, MANLU ZHUa, WEN WANGa a The National Center of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China b Beijing Huilan Hospital, Beijing, China c Beijing Highland Med-Tech Development Co. Ltd, Beijing, China