What factors contribute to the inadequate control of elevated blood pressure?

Inadequate control of blood pressure may be attributed to both provider-related and patient-related factors. Health care provider-related factors may include an excessive reliance on monotherapy and reluctance to increase drug doses or add additional antihypertensive agents to the treatment regimen. The primary patient-related factor is nonadherence with the prescribed antihypertensive medication.

Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis.

Background: The effect of different classes of antihypertensive drugs on incident diabetes mellitus is controversial because traditional meta-analyses are hindered by heterogeneity across trials and the absence of trials comparing angiotensin-converting-enzyme (ACE) inhibitors with angiotensin-receptor blockers (ARB). We therefore undertook a network meta-analysis, which accounts for both direct and indirect comparisons to assess the effects of antihypertensive agents on incident diabetes.

Methods: We undertook a systematic review up to Sept 15, 2006, and identified 48 randomised groups of 22 clinical trials with 143,153 participants who did not have diabetes at randomisation and so were eligible for inclusion in our analysis.

Drug interactions and drugs that affect blood pressure.

Many antihypertensive drugs have important interactions with drugs used for different purposes; when these are used concomitantly, adverse effects on blood pressure can result. Fortunately, in recent years, the drug development process has generally discouraged the approval and marketing of antihypertensive drugs with this problem, although some anomalies still exist (eg, telmisartan + digoxin). Physicians who work in emergency departments are more familiar with illicit or unregulated drugs that affect blood pressure; chief among these are cocaine and other opioids, and methylphenidate and its congeners.

Cardiovascular events in hypertension trials of Angiotensin-converting enzyme inhibitors.

Angiotensin-converting enzyme inhibitors are widely-prescribed drugs for hypertension and are supported by clinical trials in which they reduce cardiovascular events. In the high-risk patients in the Heart Outcomes Prevention Evaluation, the Perindopril Protection Against Recurrent Stroke Study, and European Trial of Reduction of Cardiac Events With Perindopril in Stable Coronary Artery Disease, ramipril and perindopril showed impressive benefits. One reason trandolapril did somewhat less well in the Prevention of Events With Angiotensin-Converting Enzyme Inhibition trial may be that its patients were very well treated with other effective modalities.

Differential effects of antihypertensive drugs on new-onset diabetes?

Since the late 1950s, new-onset diabetes has been a recognized adverse effect of some antihypertensive drugs. Although diagnostic criteria for diabetes mellitus have changed greatly since then, epidemiologic and physiologic studies suggest that there are differences in glucose tolerance and incident diabetes across antihypertensive drug classes. Data about incident diabetes are now available from 16 long-term, randomized, clinical trials of antihypertensive drugs.

Optimizing medication adherence in older persons with hypertension.

Suboptimal control of hypertension in large communities can be attributed, in part, to about 50% of patients who stop taking their antihypertensive drugs after 1 year. Older patients with many illnesses (including chronic kidney disease) are at especially high risk for discontinuing prescribed medications, but age is a weaker predictor than the number of consumed pills. Determining if medications are being taken as prescribed is difficult, but asking the patient and significant other the simple question, "Have you missed any pills in the last week?" is a good place to start.