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Joint National Committee (joint + national_committee)
Selected AbstractsPrevalence of risk factors for cardiovascular disease in HIV-infected patients over time: the Swiss HIV Cohort StudyHIV MEDICINE, Issue 6 2006TR Glass Objective Metabolic changes caused by antiretroviral therapy (ART) may increase the risk of coronary heart disease (CHD). We evaluated changes in the prevalence of cardiovascular risk factors (CVRFs) and 10-year risk of CHD in a large cohort of HIV-infected individuals. Methods All individuals from the Swiss HIV Cohort Study (SHCS) who completed at least one CVRF questionnaire and for whom laboratory data were available for the period February 2000 to February 2006 were included in the analysis. The presence of a risk factor was determined using cut-offs based on the guidelines of the National Cholesterol Education Program (NCEP ATP III), the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), the American Diabetes Association, and the Swiss Society for Cardiology. Results Overall, 8033 individuals completed at least one CVRF questionnaire. The most common CVRFs in the first completed questionnaire were smoking (57.0%), low high-density lipoprotein (HDL) cholesterol (37.2%), high triglycerides (35.7%), and high blood pressure (26.1%). In total, 2.7 and 13.8% of patients were categorized as being at high (>20%) and moderate (10,20%) 10-year risk for CHD, respectively. Over 6 years the percentage of smokers decreased from 61.4 to 47.6% and the percentage of individuals with total cholesterol >6.2 mmol/L decreased from 21.1 to 12.3%. The prevalence of CVRFs and CHD risk was higher in patients currently on ART than in either pretreated or ART-naive patients. Conclusion During the 6-year observation period, the prevalence of CVRFs remains high in the SHCS. Time trends indicate a decrease in the percentage of smokers and individuals with high cholesterol. [source] Effectiveness and safety of eprosartan on pulse pressure for the treatment of hypertensive patientsINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 4 2005N. R. Robles Summary A multicentre, prospective, non-comparative open-label study was conducted to assess the effect of eprosartan, 600 mg/day, on pulse pressure (PP) in patients with hypertension (stage I or II, Joint National Committee, sixth report) treated in the primary care setting, as well as safety and compliance. The duration of treatment was 16 weeks. Eprosartan decreased PP (,13 mmHg), systolic blood pressure (SBP) (,26 mmHg), diastolic blood pressure (DBP) (,13 mmHg) and mean arterial pressure (MAP) (,17.4 mmHg) significantly (p < 0.0001). The PP/MAP ratio changed significantly from 62 to 59%, so that the reduction of PP was 3% higher than the overall decrease in MAP. Twenty adverse events, mostly gastrointestinal complaints, were recorded in 12 patients (1.9%). Compliance with treatment at the end of the study was 94%. Eprosartan was a well-tolerated and an effective drug in reducing PP, SBP and DBP below the recommended levels in patients with mild-to-moderate essential hypertension, allowing a high therapeutic compliance. [source] Risk-Based Classification of Hypertension and the Role of Combination TherapyJOURNAL OF CLINICAL HYPERTENSION, Issue 2008Matthew R. Weir MD The recognition of a continuous relationship between elevated blood pressure (BP) and cardiovascular risk has influenced national and international guidelines for the classification, prevention, and management of hypertension. The most recent report (2003) of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure uses BP thresholds to define categories of normal, prehypertension, and hypertension. A new definition proposed by the Hypertension Writing Group in 2005 offers an approach to diagnosis and management based on global or total risk. Thus, even in the absence of sustained elevations in BP, patients may have a moderate to high risk of vascular events due to the presence of additional cardiovascular risk factors, disease markers, and target organ damage. The 2007 European guidelines continue to classify hypertension based on cutoffs while also placing emphasis on multivariate formulations for cardiovascular risk assessment and goals of therapy. All 3 sets of guidelines acknowledge the necessity of using ,2 antihypertensive agents to attain BP goals in many patients. [source] Emerging Insights in the First-Step Use of Antihypertensive Combination TherapyJOURNAL OF CLINICAL HYPERTENSION, Issue 2007Keith Norris MD The blood pressure (BP) goals set by hypertension management guidelines (<140/90 mm Hg in uncomplicated hypertension; <130/80 mm Hg in type 2 diabetes or kidney disease) are not being achieved in a high proportion of patients, partly because monotherapy is insufficient in many patients. In particular, patients with uncontrolled moderate or severe hypertension and/or associated cardiovascular risk factors remain at high risk for cardiovascular events and hypertensive emergency. In recognition of the urgency of treating moderate and severe hypertension, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) advocates the initial use of 2-drug therapies in patients with systolic BP levels >20 mm Hg above goal or diastolic BP level >10 mm Hg above goal. Regimens should usually include a thiazide diuretic and, for patients with diabetes or kidney disease, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Recently, clinical trial data have shown that first-step antihypertensive treatment of moderate and severe hypertension with carefully chosen fixed-dose combinations provides a high rate of BP goal achievement, a simplified dosing regimen, and superior tolerability compared with monotherapy. [source] Microalbuminuria: Definition, Detection, and Clinical SignificanceJOURNAL OF CLINICAL HYPERTENSION, Issue 2004Robert D. Toto MD Proteinuria is a sign of abnormal excretion of protein by the kidney but is a nonspecific term including any or all proteins excreted. In contrast, albuminuria specifically refers to an abnormal excretion rate of albumin. Microalbuminuria refers to an abnormally increased excretion rate of albumin in the urine in the range of 30,299 mg/g creatinine. It is a marker of endothelial dysfunction and increased risk for cardiovascular morbidity and mortality especially, but not exclusively, in high-risk populations such as diabetics and hypertensives. Testing for microalbuminuria is now made easy by in-office dipstick tests (semi-quantitative) and widely available laboratory testing (quantitative). Physicians should screen all diabetics for albuminuria and strongly consider screening hypertensives to identify those at higher risk for cardiovascular disease. Appropriate intervention, including use of drugs that block the renin-angiotensin-aldosterone system, may be appropriate in such cases as suggested by the American Diabetes Association and the Seventh Report of Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. [source] Update on the Management of Hypertension: Recent Clinical Trials and the JNC 7JOURNAL OF CLINICAL HYPERTENSION, Issue 2004Marvin Moser MD Editor in Chief The following issues are highlighted: Emphasis is placed on the importance of systolic blood pressure elevations in estimating risk and in determining prognosis. A review of placebo-controlled clinical trials indicates that cardiovascular events are statistically significantly reduced with diuretic- or , blocker-based treatment regimens. The question of whether blood pressure lowering alone or specific medications make the difference in outcome is discussed. Based on the results of numerous trials, it is apparent that blood pressure lowering itself is probably of greater importance in reducing cardiovascular events than the specific medication used. Meta-analyses suggest, however, that the use of an agent that blocks the renin-angiotensin aldosterone system is probably more effective in diabetics and in patients with nephropathy than a regimen based on calcium channel blocker therapy. The Antihypertensive and Lipid-Lowering treatment to Prevent Heart Attack Trial (ALLHAT) reported no overall difference in coronary heart disease outcome among patients treated with a diuretic-based compared to a calcium channel blocker- or an angiotensin-converting enzyme inhibitor-based treatment program. However, patients in the diuretic group experienced fewer episodes of heart failure than in the calcium channel blocker group and fewer episodes of heart failure and strokes than those in the angiotensin-converting enzyme inhibitor group. Results were similar in diabetics and nondiabetics. Possible reasons for this outcome are discussed. The Australian National Blood Pressure 2 study, which was unblinded, reported a marginally significantly better outcome only in male patients receiving an angiotensin-converting enzyme inhibitor-based regimen compared to those receiving a diuretic-based program. Finally, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) is reviewed. Highlights of this report include the new designation of prehypertension, i.e., blood pressures of 120,139 mm Hg/80,89 mm Hg. The JNC 7 suggested that diuretics should be the first-step drug of choice in most patients, but listed numerous specific reasons why other agents should be used in special situations. The report stressed that the majority of patients will require two or more medications to achieve goal blood pressure. [source] Patient Knowledge and Awareness of Hypertension Is Suboptimal: Results From a Large Health Maintenance OrganizationJOURNAL OF CLINICAL HYPERTENSION, Issue 4 2003Mark Alexander PhD; Patient knowledge and awareness of hypertension are important factors in achieving blood pressure control. To examine hypertensive patients' knowledge of their condition, the authors randomly surveyed 2500 hypertension patients from a large health maintenance organization; questionnaires were supplemented with clinic blood pressure measurements. Approximately 72% of the subjects completed surveys. Of patients with uncontrolled hypertension (systolic blood pressure [SBP] 140 mm Hg and/or diastolic blood pressure [DBP] 90 mm Hg), only 20.2% labeled their blood pressure as "high" and 38.4% as "borderline high." Forty percent of respondents couldn't recall their most recent clinic-based SBP and DBP values. Overall, 71.7% and 61% were unable to report a target SBP or DBP, respectively, or identify elevated targets based on the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) criteria. Most patients perceived DBP to be a more important risk factor than SBP. Hypertensive patients' awareness of blood pressure targets and current hypertension control status, particularly with respect to SBP, is suboptimal. The authors' findings support the need to improve patient education for better management of hypertension. [source] Achieving Goal Blood Pressure in Patients With Type 2 Diabetes: Conventional Versus Fixed-Dose Combination ApproachesJOURNAL OF CLINICAL HYPERTENSION, Issue 3 2003George L. Bakris MD Data from the Third National Health and Nutrition Examination Survey (NHANES III) demonstrate that only 11% of people with diabetes who are treated for high blood pressure achieve the blood pressure goal of <130/85 mm Hg recommended in the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). The current study tests the hypothesis that initial therapy with a fixed-dose combination will achieve the recommended blood pressure goal in patients with type 2 diabetes faster than conventional monotherapy. This randomized, double-blind, placebo-controlled study had as a primary end point achievement of blood pressure <130/85 mm Hg. Participants (N=214) with hypertension and type 2 diabetes received either amlodipine/benazepril 5/10 mg (combination) or enalapril 10 mg (conventional) once daily for 4 weeks, titrated to 5/20 mg/day or 20 mg/day, respectively at this time, if target blood pressure was not achieved. Hydrochlorothiazide (HCTZ) 12.5 mg/day was added for the final 4 weeks, if target blood pressure was still not reached. Time from baseline to achieve blood pressure <130/85 mm Hg was shorter in the combination group (5.3±3.1 weeks combination vs. 6.4±3.8 weeks conventional; p=0.001). At 3 months, more participants in the combination group achieved treatment goal (63% combination vs. 37% conventional; p=0.002). Data analysis at 3 months comparing blood pressure control rates between the fixed-dose combination group (with out HCTZ) to the conventional group (receiving HCTZ) showed an even greater disparity in blood pressure goal achievement (87% combination without HCTZ vs. 37% conventional group with HCTZ; p=0.0001). We conclude that initial therapy with a fixed-dose combination may be more efficacious than conventional monotherapy approaches for achieving blood pressure goals in the diabetic patient. A fixed-dose combination approach appears as safe as the current conventional approaches. [source] Characteristics of contemporary patients with hypertension and coronary artery diseaseCLINICAL CARDIOLOGY, Issue 10 2004Rhonda M. Cooper-DeHoff PHARM.D. Abstract Background: Despite a high prevalence of hypertension in the population with CAD, there are limited data describing the clinical characteristics and treatments, as well as their interrelations in these patients. This is particularly true for black and Hispanic patients who have been underrepresented in randomized CAD trials. Hypothesis: There exist racial and ethnic differences that define the characteristics of patients with both coronary artery disease (CAD) and hypertension. Methods: This report describes the characteristics of Caucasian, Hispanic, and black patients enrolled in the International Verapamil SR/trandolapril Study (INVEST), a prospective trial undertaken exclusively in patients with CAD and hypertension. Results: In all, 10,925 Caucasian, 8,045 Hispanic, and 3,029 black patients are described. An abnormal angiogram or documented myocardial infarction was observed more frequently in Caucasian patients (73%), while angina pectoris was more prevalent in Hispanic patients (87%). Diabetes and left ventricular hypertrophy were most common in black patients (33 and 29%, respectively), while hypercholesterolemia and prior revascularization (coronary artery bypass graft or angioplasty) were most common in Caucasian patients (64 and 41%, respectively). More than 60% of Hispanic and black patients were women,a unique characteristic for randomized CAD trials. Comparing race/ethnic cohorts, there were significant differences for all characteristics. More than 80% of patients in all race/ethnic groups were receiving antihypertensive therapy; however, only fewer than 25% had controlled blood pressure according to guidelines from the sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Conclusions: This high-risk population of hypertensive patients with CAD has been undertreated and does not have well-controlled B P. Race/ethnic differences were observed for clinical characteristics and medication use. [source] Characteristics of patients with coronary artery disease and hypertension: A report from INVESTCLINICAL CARDIOLOGY, Issue S5 2001Serap Erdine M.D. Abstract In all, 22,599 patients with coexisting hypertension and coronary artery disease (CAD) from around the world are enrolled in the INternational VErapamil SR/trandolapril STudy (INVEST). As a result, much will be learned regarding the use of treatment strategies using verapamil SR and atenolol with and without trandolapril and/or hydrochlororthiazide in patients with hypertension and CAD, all of whom are at high risk for adverse cardiovascular outcomes. This trial will provide meaningful data on optimal treatment strategies for hypertension, especially among patients who are elderly, have diabetes, have left ventricular hypertrophy, or who are dyslipidemic. This trial will be the first to use Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) guidelines as blood pressure goals to determine the relative benefits of a calcium antagonist versus a beta-blocker strategy in reducing morbidity and mortality. In addition, women and Hispanic patients participating in INVEST will provide the largest controlled experience in the management of hypertensive patients with CAD, facilitating the development of future guidelines. [source] | ||||||||||