Precision Medicine
Paul Cerrato, John Halamka in Reinventing Clinical Decision Support, 2020
Any discussion of the role of precision medicine in clinical decision making needs to start with a definition of terms. In one pilot study, physicians were given access to one group of patients' family history along with whole genome-sequencing reports that had previously been reviewed by genetic experts; a second group only provided a family history report to their physician. Other thought leaders have a somewhat different perspective on personalized/precision medicine. That view states that most clinicians already use a personalized approach to patient care when they take into account a patient’s age, gender, and family history to prescribe an antihypertensive drug, for example. In this view, a precision medicine approach would take into account the patient’s genome, using any pathologic mutations to further tailor their regimen. Similarly, a more precise treatment regimen might take into account the individual’s dietary habits and their exposure to environmental toxins and occupational hazards, to name only a few variables.
The benefits of treating hypertension in the elderly
Norman M Kaplan in Hypertension in the Elderly: Pocketbook, 1999
The four RCTs comparing ACEIs against placebo involved patients whose primary problem was coronary disease and not hypertension. The largest by far, the Heart Outcomes Prevention Evaluation (HOPE) trial (2000), included 4355 hypertensive patients, but most were on other antihypertensive drugs and the average blood pressure of the entire 9297 patient population at entry into the trial was only 139/79 mmHg. Despite only a 3/1 mmHg further lowering of BP, significant reductions in all major end-points were seen in those given the ACEI ramipril.
Improving compliance
Norman M Kaplan in Hypertension in the Elderly: Pocketbook, 1999
Fewer than half of patients begun on antihypertensive therapy will still be taking their medication after 1 year. According to a survey of over 1000 hypertensives in England reported by Jones et al. (1995), the continuation rates at 6 months were between 40 and 50% regardless of the class of antihypertensive drug prescribed. On the other hand, Monane et al. (1997) found better compliance with other classes than with diuretics among a group of 8600 elderly hypertensives enrolled in the New Jersey Medicare program from 1982 to 1988. Compliance worsened when multiple drugs were prescribed and improved with more physician visits.
Perspectives on the management of hypertension in Japan
Published in Expert Opinion on Pharmacotherapy, 2020
Tatsuya Maruhashi, Yasuki Kihara, Yukihito Higashi
ABSTRACT Introduction Hypertension is the most prevalent disease in Japan. However, it is estimated that only 50% of hypertensive patients receiving antihypertensive drug treatment achieve blood pressure of less than 140/90 mmHg. Consequently, hypertension is the leading cause of cardiovascular death in Japan. Innovative high-risk strategies are necessary to reduce hypertension-related morbidity and mortality in Japan. Areas covered This perspective summarizes the current prescription status of antihypertensive drug treatment, the clinical role of antihypertensive drug treatment in the management of hypertension and provides future perspectives in the management of hypertension in Japan. Expert opinion Earlier and lower blood pressure control throughout 24 h is currently recommended for the management of hypertension. Management of nighttime blood pressure is clinically important since nighttime blood pressure has been shown to be more closely associated than daytime blood pressure with cardiovascular events in patients receiving antihypertensive drug treatment. An appropriate selection of antihypertensive drugs and bedtime dosing of antihypertensive drugs may be effective for reducing nighttime blood pressure. The development and advancement of home blood pressure monitoring would enable tailor-made antihypertensive drug treatment.
Relationship between doses of antihypertensive drugs and left ventricular mass index changes in hemodialysis patients in a Japanese cohort
Published in Renal Failure, 2021
Fumiya Kitamura, Makoto Yamaguchi, Takayuki Katsuno, Hironobu Nobata, Shiho Iwagaitsu, Hirokazu Sugiyama, Hiroshi Kinashi, Shogo Banno, Masahiko Ando, Yoko Kubo, Yasumasa Kawade, Iwashima Shigejiro, Yutaka Ito, Takuji Ishimoto, Yasuhiko Ito
Left ventricular hypertrophy commonly occurs in dialysis patients and is associated with a risk of developing cardiovascular disease events and all-cause mortality. Although hypertension treatment reduces left ventricular mass index (LVMI) in hemodialysis patients, the relationships of prescription pattern, dose, and changes in the dose of antihypertensive drugs with LVMI have not been completely elucidated. Here, we hypothesized that volume reduction would lead to a decrease in the antihypertensive drug dose and subsequently to a reduction in LVMI; conversely, fluid retention would lead to an increase in the antihypertensive drug use and, subsequently, to LVMI progression. To assess this hypothesis, we investigated the relationship between changes in the dose of antihypertensive drugs and subsequent changes in LVMI in 240 patients who had just started hemodialysis using a retrospective hemodialysis cohort in Japan. Using multiple linear regression analysis, we assessed the association between changes in the antihypertensive drug dose over 1 year after hemodialysis initiation and changes in LVMI during this period. A decrease and an increase in the antihypertensive drug dose were significantly associated with a reduction in LVMI (vs. no change; β = – 17.386, p < .001) and LVMI progression (vs. no change; β = 16.192, p < .001), respectively. In conclusion, our findings suggested that volume reduction, leading to a decrease in the use of antihypertensive drugs, is a therapeutic strategy in patients undergoing hemodialysis to prevent LVMI progression.
Improved Synthesis of Irbesartan, an Antihypertensive Active Pharmaceutical Ingredient
Published in Synthetic Communications, 2005
Bollikonda Satyanarayana, Yasareni Sumalatha, Sundram Venkatraman, Ghanta Mahesh Reddy, Padi Pratap Reddy
An improved synthesis of the antihypertensive drug irbesartan, based on the Suzuki reaction, has been described.
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