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Blood pressure response of eplerenone according to baseline characteristics
218A
POSTERS: Epidemiology/Special Populations
all computerized health records in the VANCHCS: 7290 pharmacologically-treated patients with diabetes were identified. This population was 96% male; an estimated 95% had type 2 diabetes. The average age was 65.4 years. Computer-accessible BP recordings taken within the previous 6 months were available in 5797 (79.5%) of these patients. These readings were stratified by JNCVI criteria and compared to our previous findings: only 1813 patients (31%) had systolic BP less than 130 mm Hg (previously 32%), while 3984 (69%) had systolic BP 3 130 mm Hg (previously 68%). 4875 patients (84%) had diastolic BP ⬍85 mm Hg (previously 84%), while 922 (16%) had diastolic BPⱖ 85 mm Hg (previously 17%). In summary, systolic hypertension is significantly more prevalent than diastolic hypertension, as before. However, in the VANCHCS, no progress has been made toward improving this BP distribution. While optimal BP may be difficult to achieve in a clinic population with a substantial turnover such as ours, traditional CME and computer reminders have had no impact on outcome. New, more effective clinical transition strategies are needed. Key Words: hypertension, diabetes mellitus, elderly
P-497 ANTIHYPERTENSIVE TREATMENT IN AN ELDERLY DANISH POPULATION - TREATMENT PATTERNS Ulrik Talleruphuus, Lia E Bang, Niels Wiinberg, Jesper Mehlsen, Tage L Svendsen. Clinical Physiology and Nuclear Medicine, Holbaek Hospital, Holbaek, Denmark; Clinical Physiology and Nuclear Medicine, Frederiksberg Hospital, Frederiksberg, Denmark; Internal Medicine, Naestved Hospital, Naestved, Denmark. Purpose: To investigate the pattern of antihypertensive treatment in an elderly representative Danish population. Methods: 5.594 persons aged 70 to 79 years were selected at random from the local community registers in Frederiksberg and Naestved communities. Age and sex were uniformly distributed in both groups. All subjects were invited by letter to blood pressure measurements and a questionnaire asking for antihypertensive treatment and other health parameters. Non-responders were reinvited. Blood pressure (BP) was obtained in a standardized way. BP was expressed as the mean of three measurements over ten minutes. BP was classified into normotensive (NT) or stage 1 to 3 according to the recommendations in JNC VI. Results: 2.806 (50.2%) of the eligible persons participated. Among these 52 were unclassified regarding treatment. Age and sex were almost uniformly distributed. 544 (30.3%) were NT and did not receive treatment. Among all the 958 (34.8%) treated subjects 248 (25.8%) were NT. 159 (26.0%) were treated with one drug, 66 (24.2%) with two, 22 (31.9%) with three and 2 with four drugs respectively. No subjects were on more than four drugs. Treatment with diuretics was observed in 650 (67.8%), with -blockers in 236 (24.6%), with calciumantagonists in 289 (30.2%) and with angiotensin-converting enzymes inhibitors and AT1receptor antagonists in 172 (18.0%). The combination of diuretics and -blockers was seen in 117 (12.2%), diuretics and angiotensin-converting enzymes inhibitors in 114 (11.9%), calciumantagonists and -block-
AJH–May 2003–VOL. 16, NO. 5, PART 2
ers in 41 (4.3%) and calciumantagonists and angiotensin-converting enzymes inhibitors in 36 (3.8%). Conclusion: Only 25.8% of the subjects in antihypertensive treatment were normotensive.This was not affected by the number of drugs the subjects received. This finding is not acceptable, bearing in mind the high risk of cardiovascular events in the elderly hypertensives. We therefore strongly suggest more intensive treament in this group. Key Words: Hypertension, Treatment, Elderly
P-498 BLOOD PRESSURE RESPONSE OF EPLERENONE ACCORDING TO BASELINE CHARACTERISTICS M Weinberger, W White, R J Weiss, A Carr, M Gatlin, R Bittman, S Krause. IN University School of Medicine, Indianapolis, IN; University of CT Health Center, Farmington, CT; Androscoggin Cardiology Associates, Auburn, ME; Southern Clinical Research & Management Inc, Augusta, GA; Pharmacia Corporation, Skokie, IL. The heterogeneity of the hypertensive population has a direct bearing on optimal hypertension management. Certain drug classes are noted to be more or less effective in patients with particular profiles.1 Thus, new agents require evaluation in a variety of patient profiles to ascertain their potential widespread usefulness. This analysis evaluates the blood pressure response of eplerenone (EPL), the first selective aldosterone blocker, according to the following characteristics: age, gender, race, body mass index (BMI), diabetes status, and aldosterone/active renin ratio. Mean Blood Pressure Reduction by Demographic Group
Characteristic Age (years): ⱖ65 (n ⫽ 36); ⬍65 (n ⫽ 222) Gender: Male (n ⫽ 321); Female (n ⫽ 197) Race: Caucasian (n ⫽ 326); Black (n ⫽ 106) Race: Caucasian (n ⫽ 326); Non-Caucasian (n ⫽ 192) BMI: ⱖ30 kg/m2 (n ⫽ 225); ⬍30 kg/m2 (n ⫽ 293) Diabetes status: Type 2 diabetes (n ⫽ 23); Non-diabetic (n ⫽ 235) Aldosterone/renin ratio: ⱖ1.05 (n ⫽ 56); ⬍1.05 (n ⫽ 178)
EPL (systolic/diastolic)
PBO (systolic/diastolic)
P Value (treatment by subgroup interaction)
⫺5.8/⫺4.9; ⫺9.1/⫺5.9 ⫺2.1/⫺2.3; 1.1/⫺1.8
0.197/0.609
⫺8.5/⫺5.9; ⫺8.6/⫺5.0
0.9/⫺1.1; 1.3/⫺2.0
0.853/0.287
⫺8.9/⫺5.6; ⫺7.5/⫺4.8
1.2/⫺1.0; 1.0/⫺1.8
0.666/0.442
⫺8.8/⫺5.6; ⫺8.0/⫺5.4
1.1/⫺1.1; 1.1/⫺2.0
0.772/0.518
⫺8.9/⫺5.6; ⫺8.3/⫺5.5
0.3/⫺0.8; 1.8/⫺2.0
0.752/0.441
⫺9.4/⫺4.7; ⫺8.7/⫺5.9
3.4/⫺2.3; 0.2/⫺1.8
0.534/0.677
⫺7.8/⫺6.1; ⫺9.4/⫺5.8
0.6/0.1; ⫺0.3/⫺3.1
0.807/0.216
Demographic data from 2 controlled trials comparing EPL 50 to 100 mg administered once or twice daily to placebo (PBO) in patients with mild-to-moderate hypertension were summarized to evaluate differences in blood pressure response. Sub-groups analyzed are depicted below: There were no significant interactions in change in BP between treatment and baseline demographic characteristics. In conclusion, the antihypertensive efficacy of eplerenone was demonstrated regardless of age, gender, race, BMI, diabetes status, or baseline aldosterone/renin ratio, making this agent an attractive treatment option for many different hypertensive patient profiles. 1 JNC VI. Arch Intern Med 1997;157:2413-46. Key Words: eplerenone, patient characteristics, antihypertensive efficacy
POSTERS: Epidemiology/Special Populations
all computerized health records in the VANCHCS: 7290 pharmacologically-treated patients with diabetes were identified. This population was 96% male; an estimated 95% had type 2 diabetes. The average age was 65.4 years. Computer-accessible BP recordings taken within the previous 6 months were available in 5797 (79.5%) of these patients. These readings were stratified by JNCVI criteria and compared to our previous findings: only 1813 patients (31%) had systolic BP less than 130 mm Hg (previously 32%), while 3984 (69%) had systolic BP 3 130 mm Hg (previously 68%). 4875 patients (84%) had diastolic BP ⬍85 mm Hg (previously 84%), while 922 (16%) had diastolic BPⱖ 85 mm Hg (previously 17%). In summary, systolic hypertension is significantly more prevalent than diastolic hypertension, as before. However, in the VANCHCS, no progress has been made toward improving this BP distribution. While optimal BP may be difficult to achieve in a clinic population with a substantial turnover such as ours, traditional CME and computer reminders have had no impact on outcome. New, more effective clinical transition strategies are needed. Key Words: hypertension, diabetes mellitus, elderly
P-497 ANTIHYPERTENSIVE TREATMENT IN AN ELDERLY DANISH POPULATION - TREATMENT PATTERNS Ulrik Talleruphuus, Lia E Bang, Niels Wiinberg, Jesper Mehlsen, Tage L Svendsen. Clinical Physiology and Nuclear Medicine, Holbaek Hospital, Holbaek, Denmark; Clinical Physiology and Nuclear Medicine, Frederiksberg Hospital, Frederiksberg, Denmark; Internal Medicine, Naestved Hospital, Naestved, Denmark. Purpose: To investigate the pattern of antihypertensive treatment in an elderly representative Danish population. Methods: 5.594 persons aged 70 to 79 years were selected at random from the local community registers in Frederiksberg and Naestved communities. Age and sex were uniformly distributed in both groups. All subjects were invited by letter to blood pressure measurements and a questionnaire asking for antihypertensive treatment and other health parameters. Non-responders were reinvited. Blood pressure (BP) was obtained in a standardized way. BP was expressed as the mean of three measurements over ten minutes. BP was classified into normotensive (NT) or stage 1 to 3 according to the recommendations in JNC VI. Results: 2.806 (50.2%) of the eligible persons participated. Among these 52 were unclassified regarding treatment. Age and sex were almost uniformly distributed. 544 (30.3%) were NT and did not receive treatment. Among all the 958 (34.8%) treated subjects 248 (25.8%) were NT. 159 (26.0%) were treated with one drug, 66 (24.2%) with two, 22 (31.9%) with three and 2 with four drugs respectively. No subjects were on more than four drugs. Treatment with diuretics was observed in 650 (67.8%), with -blockers in 236 (24.6%), with calciumantagonists in 289 (30.2%) and with angiotensin-converting enzymes inhibitors and AT1receptor antagonists in 172 (18.0%). The combination of diuretics and -blockers was seen in 117 (12.2%), diuretics and angiotensin-converting enzymes inhibitors in 114 (11.9%), calciumantagonists and -block-
AJH–May 2003–VOL. 16, NO. 5, PART 2
ers in 41 (4.3%) and calciumantagonists and angiotensin-converting enzymes inhibitors in 36 (3.8%). Conclusion: Only 25.8% of the subjects in antihypertensive treatment were normotensive.This was not affected by the number of drugs the subjects received. This finding is not acceptable, bearing in mind the high risk of cardiovascular events in the elderly hypertensives. We therefore strongly suggest more intensive treament in this group. Key Words: Hypertension, Treatment, Elderly
P-498 BLOOD PRESSURE RESPONSE OF EPLERENONE ACCORDING TO BASELINE CHARACTERISTICS M Weinberger, W White, R J Weiss, A Carr, M Gatlin, R Bittman, S Krause. IN University School of Medicine, Indianapolis, IN; University of CT Health Center, Farmington, CT; Androscoggin Cardiology Associates, Auburn, ME; Southern Clinical Research & Management Inc, Augusta, GA; Pharmacia Corporation, Skokie, IL. The heterogeneity of the hypertensive population has a direct bearing on optimal hypertension management. Certain drug classes are noted to be more or less effective in patients with particular profiles.1 Thus, new agents require evaluation in a variety of patient profiles to ascertain their potential widespread usefulness. This analysis evaluates the blood pressure response of eplerenone (EPL), the first selective aldosterone blocker, according to the following characteristics: age, gender, race, body mass index (BMI), diabetes status, and aldosterone/active renin ratio. Mean Blood Pressure Reduction by Demographic Group
Characteristic Age (years): ⱖ65 (n ⫽ 36); ⬍65 (n ⫽ 222) Gender: Male (n ⫽ 321); Female (n ⫽ 197) Race: Caucasian (n ⫽ 326); Black (n ⫽ 106) Race: Caucasian (n ⫽ 326); Non-Caucasian (n ⫽ 192) BMI: ⱖ30 kg/m2 (n ⫽ 225); ⬍30 kg/m2 (n ⫽ 293) Diabetes status: Type 2 diabetes (n ⫽ 23); Non-diabetic (n ⫽ 235) Aldosterone/renin ratio: ⱖ1.05 (n ⫽ 56); ⬍1.05 (n ⫽ 178)
EPL (systolic/diastolic)
PBO (systolic/diastolic)
P Value (treatment by subgroup interaction)
⫺5.8/⫺4.9; ⫺9.1/⫺5.9 ⫺2.1/⫺2.3; 1.1/⫺1.8
0.197/0.609
⫺8.5/⫺5.9; ⫺8.6/⫺5.0
0.9/⫺1.1; 1.3/⫺2.0
0.853/0.287
⫺8.9/⫺5.6; ⫺7.5/⫺4.8
1.2/⫺1.0; 1.0/⫺1.8
0.666/0.442
⫺8.8/⫺5.6; ⫺8.0/⫺5.4
1.1/⫺1.1; 1.1/⫺2.0
0.772/0.518
⫺8.9/⫺5.6; ⫺8.3/⫺5.5
0.3/⫺0.8; 1.8/⫺2.0
0.752/0.441
⫺9.4/⫺4.7; ⫺8.7/⫺5.9
3.4/⫺2.3; 0.2/⫺1.8
0.534/0.677
⫺7.8/⫺6.1; ⫺9.4/⫺5.8
0.6/0.1; ⫺0.3/⫺3.1
0.807/0.216
Demographic data from 2 controlled trials comparing EPL 50 to 100 mg administered once or twice daily to placebo (PBO) in patients with mild-to-moderate hypertension were summarized to evaluate differences in blood pressure response. Sub-groups analyzed are depicted below: There were no significant interactions in change in BP between treatment and baseline demographic characteristics. In conclusion, the antihypertensive efficacy of eplerenone was demonstrated regardless of age, gender, race, BMI, diabetes status, or baseline aldosterone/renin ratio, making this agent an attractive treatment option for many different hypertensive patient profiles. 1 JNC VI. Arch Intern Med 1997;157:2413-46. Key Words: eplerenone, patient characteristics, antihypertensive efficacy