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Current situation of arterial hypertension in elderly people in Spain
AJH–APRIL 2000 –VOL. 13, NO. 4, PART 2
patients (40 to 49 years), and rose to 50% in olders (ⱖ 70 years). In contrast, the D and SD subtypes were more common between 30 and 59 years (P ⬍⬍0.01). In conclusion, the ambulatory pattern of hypertension showed an initial transition from S to D, and a late transition from D to S, resembling the age related change in PP. Key Words: ABPM; patterns; age
G008 POSTMARKETING SURVEILLANCE STUDY OF AMLODIPINE. COMPARATIVE RESULTS FOR HIPERTENSIVE PATIENTS WITH AND WITHOUT CONCOMITANT HYPERCHOLESTEROLEMIA A. Gil-Miguel, R. Jime´nez-Garcia, P. Carrasco, J. Martinez*, I. Ferna´ndez*, J. Espejo*. Department of Preventive Medicine. Medical School. Rey Juan Carlos University. Madrid. Spain. *Medical Division. Pfizer, Spain Objetive. To assess the safety and effectiveness of amlodipine in monotherapy and as a combination therapy for the treatment of hypertensive patients previously uncontrolled despite pharmacological treatment, analysis is performed for patients with and without concomitant hypercholesterolemia (cholesterol ⬎200 mg/dl). Design and Methods. Prospective, multicenter, postmarketing surveillance study. We included 2628 hypertensive patients (SBPⱖ140 and/or DBPⱖ90 mmHg) uncontrolled despite pharmacological treatment. Randomly selected physicians in Primary Care Setting carried out patient selection. Patients receive either amlodipine in monotherapy (70%) or amlodipine in concomitant with another antihypertensive drugs (30%). The follow up period lasted four months and each patient should have at least three visits during this period. The initial daily dose of amlodipine was 5 mg; afterwards this dose could be increased to 10 mg/day in order to achieve hypertension control (SBP ⬍140 and DBP ⬍90 mmHg). The main outcome measures included blood pressure and incidence of adverse events. Results. The mean age for the entire population was 60.7 years (SD 10.5), 55% of the patients were females. 193 of the patients recruited suffered hypercholesterolemia, the mean age for this group was 62.6 (SD 9.55) being 56% females. No significant differences were found between the incidence of adverse events in the group with hypercholesterolemia (4.7%) and those without (3.8%). After 4 months of treatment 24% of the patients with concomitant hypercholesterolemia had reached SBP⬍140 mmHg and DBP⬍90 mmHg, this percentage was 28.9% for the group without this concomitant pathology. These results and the percentage of patients that reached SBPⱕ140 mmHg and DBPⱕ90 mmHg appear in the table. Amlodipine was equally effective to reduce SBP and DBP in both of the groups compared, independently if used as monotherapy or as part of a combination therapy. Conclusion. Amlodipine is a safe and effective antihypertensive drug, as monotherapy or as part of a combination regimen, for patients previously uncontrolled despite pharmacological treatment, either if they suffer or not concomitant hypercholesterolemia.
POSTERS: Epidemiology/Special Populations
Hypercholesterolemia SBP ⬍ 140/DBP ⬍ 90 SBP ⱕ 140/DBP ⱕ 90
24% 59.2%
255A
No Hypercholesterolemia
p
28.9% 58.2%
N.S. N.S.
Key Words: Safety; effectiveness; hypercholesterolemia; amlodipine
G009 CURRENT SITUATION OF ARTERIAL HYPERTENSION IN ELDERLY PEOPLE IN SPAIN J.L. Rodicio(*), P. Aranda(*), F.J. Aranda, M. Luque, N. Martell. Spanish Hypertension Society. Carlos Haya Hospital. Malaga. Spain Our aim was to know the current situation of the Spanish elderly hypertensives trougouth a pooled analysis of the main epidemiological studies. Cardiovascular diseases supposed 52 % of all deaths in Spanish people over 65 years. From different cross-sectional studies we assume a prevalence of hypertension (BPⱖ140 and or 90 mmHg) of 61.4% (64,8% women and 58% men) and of Isolated Systolic Hypertension of 41,4% (43% women and 39.4% in men) among people over 65 years. Regarding their situation: 87% aware their hypertension and 72% are treated. Only 16.3% hypertensives are under control (BP ⬍ 140 ⫾ 90 mmHg) but if we consider a BP ⱕ 140/90 mmHg this rate increases to 30,1%. In relation to the ISH only 12% are controlled. Although 87,5% of the Spanish doctors consider a DBP ⬍ 90 mmHg as the target BP level for elderly hypertensives, only 23,3% agree with a SBP ⬍ 140 mmHg in people above 65 years. We found a high percentage of associated c-v risk factors and concomitant diseases (%): Obesity: 29,3%; Hypercholesterolemie: 26,2; Diabetes: 24,6; Smoking: 16,8; Stroke: 10,6; IHD: 33,9; CHF: 14,9; Arrythmias: 16,4; C Renal F: 19,5; Intermitent Claudication: 15,8; Osteoarthrosis: 37.6; Depression: 23, and Chronic Bronchitis: 12,4%. Use of antihypertensives (%): Diuretics: 31; BBs: 6,8; ACEIs: 39,5; CCBs: 28,5; Others groups: 4,2. 66% of the hypertensives were treated with monotherapie, 29 % with a variety of 2 drugs in combination and only 5% received three or more drugs. 85% of the patients declare different degrees of noncompliance with pharmacologic regimens. In conclusion, arterial hypertension remains as the more important c-v risk factor in the Spanish elderly population not only due to its high prevalence and insufficient degree of control, but also because of the quite common clustering with other cardiovascular risk factors. ACE inhibitors and diuretics are the more used antihypertensive drugs. Although a high percentage of the hypertensives are treated, we need to implement their control by using more adequate therapeutic strategies and improving the patient’s compliance. Key Words: Elderly hypertensives; epidemiology; treatment
patients (40 to 49 years), and rose to 50% in olders (ⱖ 70 years). In contrast, the D and SD subtypes were more common between 30 and 59 years (P ⬍⬍0.01). In conclusion, the ambulatory pattern of hypertension showed an initial transition from S to D, and a late transition from D to S, resembling the age related change in PP. Key Words: ABPM; patterns; age
G008 POSTMARKETING SURVEILLANCE STUDY OF AMLODIPINE. COMPARATIVE RESULTS FOR HIPERTENSIVE PATIENTS WITH AND WITHOUT CONCOMITANT HYPERCHOLESTEROLEMIA A. Gil-Miguel, R. Jime´nez-Garcia, P. Carrasco, J. Martinez*, I. Ferna´ndez*, J. Espejo*. Department of Preventive Medicine. Medical School. Rey Juan Carlos University. Madrid. Spain. *Medical Division. Pfizer, Spain Objetive. To assess the safety and effectiveness of amlodipine in monotherapy and as a combination therapy for the treatment of hypertensive patients previously uncontrolled despite pharmacological treatment, analysis is performed for patients with and without concomitant hypercholesterolemia (cholesterol ⬎200 mg/dl). Design and Methods. Prospective, multicenter, postmarketing surveillance study. We included 2628 hypertensive patients (SBPⱖ140 and/or DBPⱖ90 mmHg) uncontrolled despite pharmacological treatment. Randomly selected physicians in Primary Care Setting carried out patient selection. Patients receive either amlodipine in monotherapy (70%) or amlodipine in concomitant with another antihypertensive drugs (30%). The follow up period lasted four months and each patient should have at least three visits during this period. The initial daily dose of amlodipine was 5 mg; afterwards this dose could be increased to 10 mg/day in order to achieve hypertension control (SBP ⬍140 and DBP ⬍90 mmHg). The main outcome measures included blood pressure and incidence of adverse events. Results. The mean age for the entire population was 60.7 years (SD 10.5), 55% of the patients were females. 193 of the patients recruited suffered hypercholesterolemia, the mean age for this group was 62.6 (SD 9.55) being 56% females. No significant differences were found between the incidence of adverse events in the group with hypercholesterolemia (4.7%) and those without (3.8%). After 4 months of treatment 24% of the patients with concomitant hypercholesterolemia had reached SBP⬍140 mmHg and DBP⬍90 mmHg, this percentage was 28.9% for the group without this concomitant pathology. These results and the percentage of patients that reached SBPⱕ140 mmHg and DBPⱕ90 mmHg appear in the table. Amlodipine was equally effective to reduce SBP and DBP in both of the groups compared, independently if used as monotherapy or as part of a combination therapy. Conclusion. Amlodipine is a safe and effective antihypertensive drug, as monotherapy or as part of a combination regimen, for patients previously uncontrolled despite pharmacological treatment, either if they suffer or not concomitant hypercholesterolemia.
POSTERS: Epidemiology/Special Populations
Hypercholesterolemia SBP ⬍ 140/DBP ⬍ 90 SBP ⱕ 140/DBP ⱕ 90
24% 59.2%
255A
No Hypercholesterolemia
p
28.9% 58.2%
N.S. N.S.
Key Words: Safety; effectiveness; hypercholesterolemia; amlodipine
G009 CURRENT SITUATION OF ARTERIAL HYPERTENSION IN ELDERLY PEOPLE IN SPAIN J.L. Rodicio(*), P. Aranda(*), F.J. Aranda, M. Luque, N. Martell. Spanish Hypertension Society. Carlos Haya Hospital. Malaga. Spain Our aim was to know the current situation of the Spanish elderly hypertensives trougouth a pooled analysis of the main epidemiological studies. Cardiovascular diseases supposed 52 % of all deaths in Spanish people over 65 years. From different cross-sectional studies we assume a prevalence of hypertension (BPⱖ140 and or 90 mmHg) of 61.4% (64,8% women and 58% men) and of Isolated Systolic Hypertension of 41,4% (43% women and 39.4% in men) among people over 65 years. Regarding their situation: 87% aware their hypertension and 72% are treated. Only 16.3% hypertensives are under control (BP ⬍ 140 ⫾ 90 mmHg) but if we consider a BP ⱕ 140/90 mmHg this rate increases to 30,1%. In relation to the ISH only 12% are controlled. Although 87,5% of the Spanish doctors consider a DBP ⬍ 90 mmHg as the target BP level for elderly hypertensives, only 23,3% agree with a SBP ⬍ 140 mmHg in people above 65 years. We found a high percentage of associated c-v risk factors and concomitant diseases (%): Obesity: 29,3%; Hypercholesterolemie: 26,2; Diabetes: 24,6; Smoking: 16,8; Stroke: 10,6; IHD: 33,9; CHF: 14,9; Arrythmias: 16,4; C Renal F: 19,5; Intermitent Claudication: 15,8; Osteoarthrosis: 37.6; Depression: 23, and Chronic Bronchitis: 12,4%. Use of antihypertensives (%): Diuretics: 31; BBs: 6,8; ACEIs: 39,5; CCBs: 28,5; Others groups: 4,2. 66% of the hypertensives were treated with monotherapie, 29 % with a variety of 2 drugs in combination and only 5% received three or more drugs. 85% of the patients declare different degrees of noncompliance with pharmacologic regimens. In conclusion, arterial hypertension remains as the more important c-v risk factor in the Spanish elderly population not only due to its high prevalence and insufficient degree of control, but also because of the quite common clustering with other cardiovascular risk factors. ACE inhibitors and diuretics are the more used antihypertensive drugs. Although a high percentage of the hypertensives are treated, we need to implement their control by using more adequate therapeutic strategies and improving the patient’s compliance. Key Words: Elderly hypertensives; epidemiology; treatment