- Email: [email protected]
Mean blood pressure improvement with combination therapy versus concomitant antihypertensive agents
62A
POSTERS: Antihypertensive Drugs
L group (n ⴝ 120)
L vs. N§ N group (n ⴝ 128)
Mean ⴞ SD Time (EH) BP (mmHg) 0 0.5 1 1.5 2 2.5 3† 3.5 4 4.5 5 5.5† 6†‡
AJH–April 2002–VOL. 15, NO. 4, PART 2
Mean ⴞ SD HR (b.p.m)
155 ⫾ 16 101 ⫾ 6 75 ⫾ 8 147 ⫾ 16* 97 ⫾ 8* 77 ⫾ 10* 142 ⫾ 15* 92 ⫾ 9* 79 ⫾ 9* 141 ⫾ 13* 91 ⫾ 9* 79 ⫾ 10* 140 ⫾ 14* 91 ⫾ 9* 79 ⫾ 9* 139 ⫾ 14* 91 ⫾ 8* 78 ⫾ 9* 140 ⫾ 14* 91 ⫾ 8* 78 ⫾ 9* 139 ⫾ 14* 90 ⫾ 8* 78 ⫾ 9* 139 ⫾ 15* 91 ⫾ 8* 79 ⫾ 10* 140 ⫾ 14* 91 ⫾ 9* 79 ⫾ 9* 140 ⫾ 14* 91 ⫾ 9* 79 ⫾ 9* 142 ⫾ 14* 92 ⫾ 9* 78 ⫾ 9* 142 ⫾ 15* 92 ⫾ 9* 78 ⫾ 9*
S/D/HR BP (mmHg) ⫺/⫺/⫺ a/c/⫺ c/c/b c/c/b c/c/c c/c/b b/c/a b/b/⫺ ⫺/⫺/⫺ ⫺/⫺/⫺ ⫺/⫺/⫺ ⫺/⫺/⫺ ⫺/⫺/⫺
HR (b.p.m.)
154 ⫾ 17 102 ⫾ 5 75 ⫾ 7 153 ⫾ 17 100 ⫾ 7 75 ⫾ 8 151 ⫾ 16* 99 ⫾ 8* 75 ⫾ 7 150 ⫾ 17* 98 ⫾ 8* 75 ⫾ 8 148 ⫾ 16* 97 ⫾ 8* 75 ⫾ 7 147 ⫾ 16* 96 ⫾ 9* 75 ⫾ 7 145 ⫾ 16* 95 ⫾ 9* 75 ⫾ 7 144 ⫾ 16* 94 ⫾ 9* 76 ⫾ 8 143 ⫾ 16* 93 ⫾ 9* 78 ⫾ 9* 142 ⫾ 16* 92 ⫾ 9* 78 ⫾ 9* 141 ⫾ 15* 92 ⫾ 9* 78 ⫾ 8* 142 ⫾ 16* 92 ⫾ 9* 78 ⫾ 8* 141 ⫾ 16* 92 ⫾ 9* 78 ⫾ 9*
† L group: n ⫽ 119; ‡ N group: n ⫽ 127. * Comparisons with EH 0 (ANOVA for repeated measurements and Dunnett’s test): P ⬍ 0.01. § P values: a ⬍ 0.05; b ⬍ 0.01; c ⬍ 0.001; ⫺: ⬎ 0.05.
Key Words: Calcium Channel Blocker, Lacidipine, Nifedipine GITS
P-83 SYMPTOMS AND THE DISTRESS THEY CAUSE: A COMPARISON OF EPLERENONE AND AMLODIPINE IN PATIENTS TREATED FOR ELEVATED SYSTOLIC BP Norman K. Hollenberg, Richard B. Anderson, Gordon H. Williams, Barbara Roniker, Scott L. Krause, Kasem S. Akhras. Brignam & Women’s Hosp., Boston, MA; CoMMensa, Inc., Arlington, MA; Pharmacia Corp., Skokie, IL. This study was designed to compare the influence of eplerenone(EPL) and amlodipine(AML) on systolic blood pressure (SBP) and on symptom distress (SDI). Patients over 50 yrs with SBP were randomized to either EPL 50mg or AML 2.5mg daily and titrated to a maximum 200mg EPL or 10mg AML dose. Patients were followed for 24 wks. Quality of life(QOL) questionnaires (SDI and SF-36 Health Survey) were administered 2-4 wks pre-randomization, 14 wks, and 24 wks after randomization. Change from baseline to week 24 in the SDI was analyzed using the Wilcoxon Rank Sum Test(WRST) to compare the ranks and first principal component analysis(FPCT). The BP response to EPL and AML did not differ (EPL⫽20.5 mmHg and AML⫽ -20.1 mmHg); 241 were eligible for the QOL analysis, of which 119 were randomized to EPL and 122 of AML. No significant treatment group differences in the SDI were detected at baseline. Both the WRST and the FPCT detected an overall significnt treatment effect in favor of EPL(p⫽0.038 & p⫽0.027). Change in SDI showed significant worsening distress in 21 of 73 symptoms in the AML arm and none in the EPL arm. Significant treatment effect in favor of EPL was observed in five symptoms: ankle swelling, weight gain, nocturia, increased urination, and shortness of breath. EPL is better tolerated than AML evidenced by symptoms frequency and by the distress associated with the symptoms. Key Words: Calcium Channel Blocker, Quality of Life, Aldosterone Antagonist
P-84 THE EFFICACY OF ANTIHYPERTENSIVE MEDICATIONS IN A PSYCHIATRIC POPULATION Naipaul Rambaran,1 Hayman Rambaran,2 David Mayerhoff. 1, Essex County Hospital Center, Cedar Grove, NJ;2, Eva’s Medical Clinic, Paterson, NJ; 3, UMDNJ, Newark, NJ. It is well known that psychiatric patients have an increased incidence of chronic medical problems with advancing age including hypertension and obesity. As part of an ongoing study we evaluated the efficacy of different classes of antihypertensive drugs currently in use for treating hypertension in the population.
Patients were selected from the inpatient units at ECHC based on medical history as well as data reviewed for weekly blood pressure readings over the last 6 months that met prior criteria for elevated Blood Pressure. Fifty-three patients met the criteria, compromising 28 females and 25 males. The mean age for the females was 59 years and males 49 years. The main body mass index was 33 for females and 30 for males. Ninety percent of the patients had Schizophrenia as the primary diagnosis. Combination therapy was used by 84 percent of the patients and the most common combination was ace/diuretic (75%), the least common single drug was angiotensin receptor blocker (3.7%). Seven patients (15%) were on ace/beta blocker combination. The standard psychotropic drugs used in various combinations were zyprexa, cogentin, haldol and risperdal. Compliance was assured by daily observation and monitoring. The average blood pressure, post treatment for the females was 138/88 and for males 140/84. Review of the data showed that the most effective lowering of the blood presure was obtained with ace/diuretics as a combination therapy, and second most effective with diuretic as mono therapy. Our data suggest that the most cost effective control of blood pressure was obtained with diuretics as a single agent and ace/diuretics as combination therapy in this chronic and persistent mentally ill population. Further studies would help to validate this observation. Key Words: Hypertension, Efficacy, Psychiatric
P-85 MEAN BLOOD PRESSURE IMPROVEMENT WITH COMBINATION THERAPY VERSUS CONCOMITANT ANTIHYPERTENSIVE AGENTS David S. Ziska, James H. Jackson, Anne T. Frechette. Applied Health Outcomes, Tampa, FL, United States. Antihypertensive treatment with two or more agents has been proven superior compared to monotherapy. JNC VI advocates combinations of low doses of two agents from different classes to provide additional antihypertensive efficacy, thereby minimizing the likelihood of dosedependent adverse effects. The aim of this retrospective study was to test whether patients with hypertension (HTN) in a managed care organization had better mean BP when receiving a fixed combination dihydropyridine calcium channel blocker (DHP-CCB)/angiotensin-converting enzyme inhibitor (ACEI) versus high dose DHP-CCB or DHP-CCB and ACEI concurrently. Ninety-three (93) patients currently receiving a DHP-CCB/ACEI combination for at least 60 days and had previously received either a DHP-CCB and ACEI as separate concurrent antihypertensives or a high dose DHPCCB were included in this study. Each patient served as his/her own control in this pre- post- analysis. The pre-combination BP was the last office BP documented before fixed combination therapy was initiated. After receiving the combination antihypertensive for at least 60 days, the most recent BP was then documented. Data was analyzed using t-test. Average age was 61.3 years and 48.4% were female. Mean pre- and postBP readings were 145.6/86.5 mmHg and 138.7/82.6 mmHg, respectively. The differences were statistically significant (p ⬍ .005). See table. Our results suggest that mean BP is reduced when a fixed combination DHP-CCB/ACEI antihypertensive is used to substitute for a high dose DHP-CCB or DHP-CCB and ACEI concurrently in a managed care patient population with HTN. Results Comparing Mean BP for Pre and Post Combination Therapy PARAMETER
c
Mean BP
SD
Pre-combination SBP Post-combination SBP Pre-combination DBP Post-combination DBP
93 93 93 93
145.6 138.7 86.5 82.6
16.9 16.1 11.2 10.3
p-value 0.0018 0.0034
Key Words: Combination Antihypertensive, Mean BP, DHP-CCB/ACEI
POSTERS: Antihypertensive Drugs
L group (n ⴝ 120)
L vs. N§ N group (n ⴝ 128)
Mean ⴞ SD Time (EH) BP (mmHg) 0 0.5 1 1.5 2 2.5 3† 3.5 4 4.5 5 5.5† 6†‡
AJH–April 2002–VOL. 15, NO. 4, PART 2
Mean ⴞ SD HR (b.p.m)
155 ⫾ 16 101 ⫾ 6 75 ⫾ 8 147 ⫾ 16* 97 ⫾ 8* 77 ⫾ 10* 142 ⫾ 15* 92 ⫾ 9* 79 ⫾ 9* 141 ⫾ 13* 91 ⫾ 9* 79 ⫾ 10* 140 ⫾ 14* 91 ⫾ 9* 79 ⫾ 9* 139 ⫾ 14* 91 ⫾ 8* 78 ⫾ 9* 140 ⫾ 14* 91 ⫾ 8* 78 ⫾ 9* 139 ⫾ 14* 90 ⫾ 8* 78 ⫾ 9* 139 ⫾ 15* 91 ⫾ 8* 79 ⫾ 10* 140 ⫾ 14* 91 ⫾ 9* 79 ⫾ 9* 140 ⫾ 14* 91 ⫾ 9* 79 ⫾ 9* 142 ⫾ 14* 92 ⫾ 9* 78 ⫾ 9* 142 ⫾ 15* 92 ⫾ 9* 78 ⫾ 9*
S/D/HR BP (mmHg) ⫺/⫺/⫺ a/c/⫺ c/c/b c/c/b c/c/c c/c/b b/c/a b/b/⫺ ⫺/⫺/⫺ ⫺/⫺/⫺ ⫺/⫺/⫺ ⫺/⫺/⫺ ⫺/⫺/⫺
HR (b.p.m.)
154 ⫾ 17 102 ⫾ 5 75 ⫾ 7 153 ⫾ 17 100 ⫾ 7 75 ⫾ 8 151 ⫾ 16* 99 ⫾ 8* 75 ⫾ 7 150 ⫾ 17* 98 ⫾ 8* 75 ⫾ 8 148 ⫾ 16* 97 ⫾ 8* 75 ⫾ 7 147 ⫾ 16* 96 ⫾ 9* 75 ⫾ 7 145 ⫾ 16* 95 ⫾ 9* 75 ⫾ 7 144 ⫾ 16* 94 ⫾ 9* 76 ⫾ 8 143 ⫾ 16* 93 ⫾ 9* 78 ⫾ 9* 142 ⫾ 16* 92 ⫾ 9* 78 ⫾ 9* 141 ⫾ 15* 92 ⫾ 9* 78 ⫾ 8* 142 ⫾ 16* 92 ⫾ 9* 78 ⫾ 8* 141 ⫾ 16* 92 ⫾ 9* 78 ⫾ 9*
† L group: n ⫽ 119; ‡ N group: n ⫽ 127. * Comparisons with EH 0 (ANOVA for repeated measurements and Dunnett’s test): P ⬍ 0.01. § P values: a ⬍ 0.05; b ⬍ 0.01; c ⬍ 0.001; ⫺: ⬎ 0.05.
Key Words: Calcium Channel Blocker, Lacidipine, Nifedipine GITS
P-83 SYMPTOMS AND THE DISTRESS THEY CAUSE: A COMPARISON OF EPLERENONE AND AMLODIPINE IN PATIENTS TREATED FOR ELEVATED SYSTOLIC BP Norman K. Hollenberg, Richard B. Anderson, Gordon H. Williams, Barbara Roniker, Scott L. Krause, Kasem S. Akhras. Brignam & Women’s Hosp., Boston, MA; CoMMensa, Inc., Arlington, MA; Pharmacia Corp., Skokie, IL. This study was designed to compare the influence of eplerenone(EPL) and amlodipine(AML) on systolic blood pressure (SBP) and on symptom distress (SDI). Patients over 50 yrs with SBP were randomized to either EPL 50mg or AML 2.5mg daily and titrated to a maximum 200mg EPL or 10mg AML dose. Patients were followed for 24 wks. Quality of life(QOL) questionnaires (SDI and SF-36 Health Survey) were administered 2-4 wks pre-randomization, 14 wks, and 24 wks after randomization. Change from baseline to week 24 in the SDI was analyzed using the Wilcoxon Rank Sum Test(WRST) to compare the ranks and first principal component analysis(FPCT). The BP response to EPL and AML did not differ (EPL⫽20.5 mmHg and AML⫽ -20.1 mmHg); 241 were eligible for the QOL analysis, of which 119 were randomized to EPL and 122 of AML. No significant treatment group differences in the SDI were detected at baseline. Both the WRST and the FPCT detected an overall significnt treatment effect in favor of EPL(p⫽0.038 & p⫽0.027). Change in SDI showed significant worsening distress in 21 of 73 symptoms in the AML arm and none in the EPL arm. Significant treatment effect in favor of EPL was observed in five symptoms: ankle swelling, weight gain, nocturia, increased urination, and shortness of breath. EPL is better tolerated than AML evidenced by symptoms frequency and by the distress associated with the symptoms. Key Words: Calcium Channel Blocker, Quality of Life, Aldosterone Antagonist
P-84 THE EFFICACY OF ANTIHYPERTENSIVE MEDICATIONS IN A PSYCHIATRIC POPULATION Naipaul Rambaran,1 Hayman Rambaran,2 David Mayerhoff. 1, Essex County Hospital Center, Cedar Grove, NJ;2, Eva’s Medical Clinic, Paterson, NJ; 3, UMDNJ, Newark, NJ. It is well known that psychiatric patients have an increased incidence of chronic medical problems with advancing age including hypertension and obesity. As part of an ongoing study we evaluated the efficacy of different classes of antihypertensive drugs currently in use for treating hypertension in the population.
Patients were selected from the inpatient units at ECHC based on medical history as well as data reviewed for weekly blood pressure readings over the last 6 months that met prior criteria for elevated Blood Pressure. Fifty-three patients met the criteria, compromising 28 females and 25 males. The mean age for the females was 59 years and males 49 years. The main body mass index was 33 for females and 30 for males. Ninety percent of the patients had Schizophrenia as the primary diagnosis. Combination therapy was used by 84 percent of the patients and the most common combination was ace/diuretic (75%), the least common single drug was angiotensin receptor blocker (3.7%). Seven patients (15%) were on ace/beta blocker combination. The standard psychotropic drugs used in various combinations were zyprexa, cogentin, haldol and risperdal. Compliance was assured by daily observation and monitoring. The average blood pressure, post treatment for the females was 138/88 and for males 140/84. Review of the data showed that the most effective lowering of the blood presure was obtained with ace/diuretics as a combination therapy, and second most effective with diuretic as mono therapy. Our data suggest that the most cost effective control of blood pressure was obtained with diuretics as a single agent and ace/diuretics as combination therapy in this chronic and persistent mentally ill population. Further studies would help to validate this observation. Key Words: Hypertension, Efficacy, Psychiatric
P-85 MEAN BLOOD PRESSURE IMPROVEMENT WITH COMBINATION THERAPY VERSUS CONCOMITANT ANTIHYPERTENSIVE AGENTS David S. Ziska, James H. Jackson, Anne T. Frechette. Applied Health Outcomes, Tampa, FL, United States. Antihypertensive treatment with two or more agents has been proven superior compared to monotherapy. JNC VI advocates combinations of low doses of two agents from different classes to provide additional antihypertensive efficacy, thereby minimizing the likelihood of dosedependent adverse effects. The aim of this retrospective study was to test whether patients with hypertension (HTN) in a managed care organization had better mean BP when receiving a fixed combination dihydropyridine calcium channel blocker (DHP-CCB)/angiotensin-converting enzyme inhibitor (ACEI) versus high dose DHP-CCB or DHP-CCB and ACEI concurrently. Ninety-three (93) patients currently receiving a DHP-CCB/ACEI combination for at least 60 days and had previously received either a DHP-CCB and ACEI as separate concurrent antihypertensives or a high dose DHPCCB were included in this study. Each patient served as his/her own control in this pre- post- analysis. The pre-combination BP was the last office BP documented before fixed combination therapy was initiated. After receiving the combination antihypertensive for at least 60 days, the most recent BP was then documented. Data was analyzed using t-test. Average age was 61.3 years and 48.4% were female. Mean pre- and postBP readings were 145.6/86.5 mmHg and 138.7/82.6 mmHg, respectively. The differences were statistically significant (p ⬍ .005). See table. Our results suggest that mean BP is reduced when a fixed combination DHP-CCB/ACEI antihypertensive is used to substitute for a high dose DHP-CCB or DHP-CCB and ACEI concurrently in a managed care patient population with HTN. Results Comparing Mean BP for Pre and Post Combination Therapy PARAMETER
c
Mean BP
SD
Pre-combination SBP Post-combination SBP Pre-combination DBP Post-combination DBP
93 93 93 93
145.6 138.7 86.5 82.6
16.9 16.1 11.2 10.3
p-value 0.0018 0.0034
Key Words: Combination Antihypertensive, Mean BP, DHP-CCB/ACEI