Pharmacy Times, Volume 0, 0

High BP Is Still Prevalent

Hypertension still remains a seriouspublic health problem, even thoughthere has been progress in the medicaltreatment of hypertension and increasedpublic health awareness to lower itsoccurrence, according to a January2008 Centers for Disease Control andPrevention report.

Data from the National Health andNutrition Examination Surveys foundthat 66% of US adults aged 18 years andolder had hypertension (29%) or prehypertension(37%) in 2005 to 2006. Of theindividuals with hypertension, 78% wereaware of their condition. Of the individualsbeing treated with antihypertensivemedication, >64% of patients achievedblood pressure (BP) <140/90 mm Hg.

The researchers concluded that increasingawareness, treatment, and BPcontrol will reduce morbidity and mortality.The results underscore the importancefor patients with high BP to monitortheir BP at home to help preventserious complications. For additionalinformation on this report, visit www.morningbp.com/pt37

Taking BP Meds: Morning or Night?

Switching the time of taking bloodpressure (BP) medications may behealthier for individuals with heart andchronic kidney disease (CKD). In healthyindividuals, BP dips at night by 10% ormore. Individuals with high BP thatdoes not dip at night (nondippers) facegreater odds of heart attack or stroke.

For the study, the researchers had 32nondippers with CKD switch 1 of their BPdrugs from morning to evening. After 8weeks, 88% of the participants hadbecome dippers, and nocturnal BP waslowered by an average 7 mm Hg withoutan increase in daytime BP. Reporting inthe December 7, 2007, issue of theAmerican Journal of Kidney Diseases, theresearchers said, "The simple maneuverof switching the time of drug administrationfrom morning to evening appears tosafely lower nocturnal BP and restore anormal diurnal BP pattern." The resultsemphasize the need for patients to monitortheir BP and share the results withtheir physician. For additional informationon this study, visit www.morningbp.com/pt38

Nighttime BP Favoredfor Prognosis

A meta-analysis of 4 prospective studies in Europefound that nighttime ambulatory blood pressure (ABP) is,in general, a better predictor of cardiovascular events,compared with daytime BP in patients with hypertension,according to a study reported in the January 2008issue of Hypertension.

Of the 3468 participants, 14% were smokers, 8% haddiabetes, and 61% were under hypertensive treatmentat the time of ABP monitoring. The researchers foundduring the 61/2 years of follow-up there were 324 deaths,72 nonfatal myocardial infarctions, and 93 nonfatalstrokes. Daytime and nighttime ABP also were majorpredictors of all-cause and cardiovascular mortality,stroke, coronary heart disease, and an aggregate ofmajor cardiovascular disease. Although nighttime ABPadded to the prognostic value of daytime ABP for alloutcomes, daytime ABP did not add prognostic precisionto nighttime ABP, reported the researchers. Thefindings show why patients need to be active participantsin treating their condition by recording their BP athome. For more information on this study, visitwww.morningbp.com/pt40

Diabetes and BP LinkFound in Women

A study, reported in the December 2007 issue of the EuropeanHeart Journal, examined the relationship of blood pressure (BP)and BP progression in the development of type 2 diabetes in38,172 women without heart disease or diabetes.

The women were divided into 4 groups according to selfreportedbaseline BP (<120/75 mm Hg, 120-129/75-84 mm Hg,130-139/85-89 mm Hg, and those with hypertension) and werefurther classified according to progression to a higher BP categoryduring the first 48 months of follow-up. During 10 years of follow-up, 1672 women developed type 2 diabetes.

The women who had a rise in BP during the study also had anincreased risk of developing type 2 diabetes. The participantswhose BP rose but who stayed within the normal BP range hadan increased risk of 26%, compared with women who had stableor decreasing BP. The women who progressed to hypertensionhad a 64% increased risk.

The researchers concluded that the study ?provides strongevidence? that BP and BP progression are related with anincreased risk of type 2 diabetes. The findings demonstrate thatwomen with increasing high BP or increasing BP consider homeBP monitoring to help prevent diabetes. For more information onthis study, visit www.morningbp.com/pt39

F A S T &#160; F A C T : High blood pressure is a modifiable risk factor for cardiovascular disease.