Abstract：
UNASSIGNED: In a prospective open study, with intervention, conducted in Primary Health Care Units by General Practitioners (GPs) in Portugal, the effectiveness of a single pill of candesartan/amlodipine (ARB/amlodipine), as the only anti-hypertension (anti-HTN) medication, in adult patients with uncontrolled HTN (BP > 140/or > 90 mm Hg), either previously being treated with anti-HTN monotherapies (Group I), or combinations with hydrochlorothiazide (HCTZ) (Group II), or not receiving medication at all (Group III), was evaluated across 12-weeks after implementation of the new therapeutic measure.
UNASSIGNED: A total of 118 GPs recruited patients with uncontrolled HTN who met inclusion/exclusion criteria. Participants were assigned, according to severity, one of 3 (morning) fixed combination candesartan/amlodipine dosage (8/5 or 16/5 or 16/10 mg/day) and longitudinally evaluated in 3 visits (v0, v6 and v12 weeks). Office blood pressure was measured in each visit, and control of HTN was defined per guidelines (BP< 140/90 mmHg).
UNASSIGNED: Of the 1234 patients approached, 752 (age 61 ± 10 years, 52% women) participated in the study and were assigned to groups according to previous treatment conditions. The 3 groups exhibited a statistically significant increased control of blood pressure after receiving the fixed combination candesartan/amlodipine dosage. The overall proportion of controlled HTN participants increased from 0,8% at v0 to 82% at v12. The mean arterial blood pressure values decreased from SBP= 159.0 (± 13.0) and DBP= 91.1 (± 9.6) at baseline to SBP= 132,1 (± 11.3) and DBP= 77,5 (± 8.8) at 12 weeks (p < 0.01). Results remained consistent when controlling for age and sex.
UNASSIGNED: In patients with uncontrolled HTN, therapeutic measures in accordance with guidelines, with a fixed combination candesartan/amlodipine, allowed to overall achieve HTN control at 12 weeks in 82% of previously uncontrolled HTN patients, reinforcing the advantages of these strategies in primary clinical practice.
What is the context?Arterial hypertension (HTN) represents the main risk factor for cause of death from cardiovascular disease (CV). Adequate control of hypertension reduces CV risk and significantly prevents CV events and associated morbidity and mortality. This requires patients’ adherence and persistence in implemented treatment and the achievement of tension targets that are related to the reduction of CV risk. The latest international recommendations indicate that hypertension control is insufficient in most countries. In Portugal, hypertension control is <43% and a significant number of patients treated do not comply with the recommendations.What is new?In a prospective, interventional, and multicentre study, carried out by General Practitioners (GPs) in Primary Health Care Units across Portugal, the objective was to determine (i) whether the presence of uncontrolled hypertension results from non-compliance with the provisions of the recommendations and the Integrated Care Process (PAI) of the Direção Geral de Saúde (DGS), i.e. inappropriate use of monotherapies or inadequate low doses of combinations of antihypertensives, and (ii) whether the adjustment of hypertension therapies, favouring the schemes provided in the recommendations, allows adequate control of arterial hypertension, in previously uncontrolled patients, when these are closely monitored in a 12-week time period.What is the impact?When the guidelines’ therapeutic protocol is followed, as established for each identified group of patients (monotherapy, hydrochlorothiazide, and no medication), results indicate a marked and statistically significant improvements in both SBP and DBP values and hypertension control across time.
UNASSIGNED: A total of 118 GPs recruited patients with uncontrolled HTN who met inclusion/exclusion criteria. Participants were assigned, according to severity, one of 3 (morning) fixed combination candesartan/amlodipine dosage (8/5 or 16/5 or 16/10 mg/day) and longitudinally evaluated in 3 visits (v0, v6 and v12 weeks). Office blood pressure was measured in each visit, and control of HTN was defined per guidelines (BP< 140/90 mmHg).
UNASSIGNED: Of the 1234 patients approached, 752 (age 61 ± 10 years, 52% women) participated in the study and were assigned to groups according to previous treatment conditions. The 3 groups exhibited a statistically significant increased control of blood pressure after receiving the fixed combination candesartan/amlodipine dosage. The overall proportion of controlled HTN participants increased from 0,8% at v0 to 82% at v12. The mean arterial blood pressure values decreased from SBP= 159.0 (± 13.0) and DBP= 91.1 (± 9.6) at baseline to SBP= 132,1 (± 11.3) and DBP= 77,5 (± 8.8) at 12 weeks (p < 0.01). Results remained consistent when controlling for age and sex.
UNASSIGNED: In patients with uncontrolled HTN, therapeutic measures in accordance with guidelines, with a fixed combination candesartan/amlodipine, allowed to overall achieve HTN control at 12 weeks in 82% of previously uncontrolled HTN patients, reinforcing the advantages of these strategies in primary clinical practice.
What is the context?Arterial hypertension (HTN) represents the main risk factor for cause of death from cardiovascular disease (CV). Adequate control of hypertension reduces CV risk and significantly prevents CV events and associated morbidity and mortality. This requires patients’ adherence and persistence in implemented treatment and the achievement of tension targets that are related to the reduction of CV risk. The latest international recommendations indicate that hypertension control is insufficient in most countries. In Portugal, hypertension control is <43% and a significant number of patients treated do not comply with the recommendations.What is new?In a prospective, interventional, and multicentre study, carried out by General Practitioners (GPs) in Primary Health Care Units across Portugal, the objective was to determine (i) whether the presence of uncontrolled hypertension results from non-compliance with the provisions of the recommendations and the Integrated Care Process (PAI) of the Direção Geral de Saúde (DGS), i.e. inappropriate use of monotherapies or inadequate low doses of combinations of antihypertensives, and (ii) whether the adjustment of hypertension therapies, favouring the schemes provided in the recommendations, allows adequate control of arterial hypertension, in previously uncontrolled patients, when these are closely monitored in a 12-week time period.What is the impact?When the guidelines’ therapeutic protocol is followed, as established for each identified group of patients (monotherapy, hydrochlorothiazide, and no medication), results indicate a marked and statistically significant improvements in both SBP and DBP values and hypertension control across time.
摘要：
■在一项前瞻性开放研究中，通过干预,由葡萄牙的全科医生(GP)在初级卫生保健单位进行，坎地沙坦/氨氯地平（ARB/氨氯地平）单药的有效性，作为唯一的抗高血压（抗HTN）药物，在HTN不受控制的成年患者中（BP>140/或>90mmHg），无论是以前用抗HTN单一疗法治疗（组I），或与氢氯噻嗪（HCTZ）（II组）的组合，或根本不接受药物治疗（第三组），在实施新的治疗措施后的12周内进行评估。
■共有118名全科医生招募了符合纳入/排除标准的未受控制的HTN患者。参与者被分配，根据严重程度，3（早晨）固定组合坎地沙坦/氨氯地平剂量（8/5或16/5或16/10mg/天）之一，并在3次访问（v0，v6和v12周）中进行纵向评估。每次就诊都测量办公室血压，并且根据指南定义了HTN的控制（BP<140/90mmHg）。
■在接受治疗的1234名患者中，752（年龄61±10岁，52％的女性）参加了研究，并根据以前的治疗情况进行了分组。在接受固定组合坎地沙坦/氨氯地平剂量后,3组显示出统计学上显著的血压控制增加。受控制的HTN参与者的总体比例从v0时的0.8％增加到v12时的82％。平均动脉血压值从基线时的SBP=159.0(±13.0)和DBP=91.1(±9.6)下降到12周时的SBP=132,1(±11.3)和DBP=77,5(±8.8)(p<0.01)。控制年龄和性别时，结果保持一致。
■在HTN不受控制的患者中，根据指导方针采取治疗措施，使用坎地沙坦/氨氯地平的固定组合，在82％的先前未控制的HTN患者中，允许在12周时总体实现HTN控制，加强这些策略在初级临床实践中的优势。
背景是什么？动脉高血压（HTN）是心血管疾病（CV）死亡的主要危险因素。适当控制高血压可降低CV风险并显著预防CV事件和相关的发病率和死亡率。这需要患者坚持和坚持实施治疗，并实现与降低CV风险相关的紧张目标。最新的国际建议表明，大多数国家的高血压控制不足。在葡萄牙,高血压控制<43%,大量接受治疗的患者不符合建议.什么是新的？在未来，介入,多中心研究，由葡萄牙各地初级卫生保健单位的全科医生(GP)进行，目的是确定（i）不受控制的高血压的存在是否由于不遵守建议的规定和DireçãoGeralerdeSaúde（DGS）的综合护理程序（PAI），即不适当使用单一疗法或低剂量的抗高血压药组合，以及(二)高血压治疗的调整，赞成建议中提供的计划，可以充分控制动脉高血压，在以前不受控制的患者中，在12周的时间内密切监测这些情况。有什么影响？当遵循指南的治疗方案时，为每个确定的患者组建立(单一疗法，氢氯噻嗪,并且没有药物治疗），结果表明,SBP和DBP值及高血压控制在不同时间均有显著且统计学显著的改善.
■共有118名全科医生招募了符合纳入/排除标准的未受控制的HTN患者。参与者被分配，根据严重程度，3（早晨）固定组合坎地沙坦/氨氯地平剂量（8/5或16/5或16/10mg/天）之一，并在3次访问（v0，v6和v12周）中进行纵向评估。每次就诊都测量办公室血压，并且根据指南定义了HTN的控制（BP<140/90mmHg）。
■在接受治疗的1234名患者中，752（年龄61±10岁，52％的女性）参加了研究，并根据以前的治疗情况进行了分组。在接受固定组合坎地沙坦/氨氯地平剂量后,3组显示出统计学上显著的血压控制增加。受控制的HTN参与者的总体比例从v0时的0.8％增加到v12时的82％。平均动脉血压值从基线时的SBP=159.0(±13.0)和DBP=91.1(±9.6)下降到12周时的SBP=132,1(±11.3)和DBP=77,5(±8.8)(p<0.01)。控制年龄和性别时，结果保持一致。
■在HTN不受控制的患者中，根据指导方针采取治疗措施，使用坎地沙坦/氨氯地平的固定组合，在82％的先前未控制的HTN患者中，允许在12周时总体实现HTN控制，加强这些策略在初级临床实践中的优势。
背景是什么？动脉高血压（HTN）是心血管疾病（CV）死亡的主要危险因素。适当控制高血压可降低CV风险并显著预防CV事件和相关的发病率和死亡率。这需要患者坚持和坚持实施治疗，并实现与降低CV风险相关的紧张目标。最新的国际建议表明，大多数国家的高血压控制不足。在葡萄牙,高血压控制<43%,大量接受治疗的患者不符合建议.什么是新的？在未来，介入,多中心研究，由葡萄牙各地初级卫生保健单位的全科医生(GP)进行，目的是确定（i）不受控制的高血压的存在是否由于不遵守建议的规定和DireçãoGeralerdeSaúde（DGS）的综合护理程序（PAI），即不适当使用单一疗法或低剂量的抗高血压药组合，以及(二)高血压治疗的调整，赞成建议中提供的计划，可以充分控制动脉高血压，在以前不受控制的患者中，在12周的时间内密切监测这些情况。有什么影响？当遵循指南的治疗方案时，为每个确定的患者组建立(单一疗法，氢氯噻嗪,并且没有药物治疗），结果表明,SBP和DBP值及高血压控制在不同时间均有显著且统计学显著的改善.
