Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2021
Non-Adherence to Antihypertensive Guidelines in Patients with Asymptomatic Carotid Stenosis.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Haley William, Shawl Fayaz, Charles Sternbergh W, Turan Tanya N, Barrett Kevin, Voeks Jenifer, Brott Thomas, Meschia James F
Аннотация
IMPORTANCE: Hypertension and carotid stenosis are both risk factors for stroke, but the presence of carotid stenosis might dampen enthusiasm for tight control of hypertension because of concerns for hypoperfusion.
OBJECTIVE: To determine the extent to which there are opportunities to potentially improve pharmacotherapy for hypertension in patients known to have asymptomatic high-grade carotid stenosis.
DESIGN: We examined anti-hypertensive medication prescription and adherence to evidence-based hypertension treatment guidelines in a cross-sectional analysis of baseline data of patients enrolled in a clinical trial.
SETTING: The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) is a multicenter prospective randomized open blinded end-point clinical trial of intensive medical management with or without revascularization by endarterectomy or stenting for asymptomatic high-grade carotid stenosis.
PARTICIPANTS: 1479 participants (38.6% female; mean age 69.8 years) from 132 clinical centers enrolled in the CREST-2 trial as of April 6, 2020 who were taking ≥1 antihypertensive drug at baseline.
EXPOSURES: Pharmacotherapy for hypertension.
MAIN OUTCOME: Adherence to evidence-based guidelines for treating hypertension.
RESULTS: Of 1458 participants with complete data, 26% were on one, 31% on 2, and 43% on ≥3 antihypertensive medications at trial entry. Thirty-two percent of participants were prescribed thiazide; 74%, angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB); 38%, calcium channel blocker (CCB); 56%, a beta blocker; 11%, loop diuretic; and 27%, other. Of those prescribed a single antihypertensive medication, the proportion prescribed thiazide was 5%; ACEI or ARB, 55%, and CCB, 11%. The prevalence of guideline-adherent regimens was 34% (95% CI, 31-36%).
CONCLUSIONS AND RELEVANCE: In a diverse cohort with severe carotid disease and hypertension, non-adherence to hypertension guidelines was common. All preferred classes of antihypertensive drug were under-prescribed. Using staged iterative guideline-based care for hypertension, CREST-2 will characterize drug tolerance and stroke rates under these conditions.
TRIAL REGISTRATION: ClinicalTrials.gov Number NCT02089217.
OBJECTIVE: To determine the extent to which there are opportunities to potentially improve pharmacotherapy for hypertension in patients known to have asymptomatic high-grade carotid stenosis.
DESIGN: We examined anti-hypertensive medication prescription and adherence to evidence-based hypertension treatment guidelines in a cross-sectional analysis of baseline data of patients enrolled in a clinical trial.
SETTING: The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) is a multicenter prospective randomized open blinded end-point clinical trial of intensive medical management with or without revascularization by endarterectomy or stenting for asymptomatic high-grade carotid stenosis.
PARTICIPANTS: 1479 participants (38.6% female; mean age 69.8 years) from 132 clinical centers enrolled in the CREST-2 trial as of April 6, 2020 who were taking ≥1 antihypertensive drug at baseline.
EXPOSURES: Pharmacotherapy for hypertension.
MAIN OUTCOME: Adherence to evidence-based guidelines for treating hypertension.
RESULTS: Of 1458 participants with complete data, 26% were on one, 31% on 2, and 43% on ≥3 antihypertensive medications at trial entry. Thirty-two percent of participants were prescribed thiazide; 74%, angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB); 38%, calcium channel blocker (CCB); 56%, a beta blocker; 11%, loop diuretic; and 27%, other. Of those prescribed a single antihypertensive medication, the proportion prescribed thiazide was 5%; ACEI or ARB, 55%, and CCB, 11%. The prevalence of guideline-adherent regimens was 34% (95% CI, 31-36%).
CONCLUSIONS AND RELEVANCE: In a diverse cohort with severe carotid disease and hypertension, non-adherence to hypertension guidelines was common. All preferred classes of antihypertensive drug were under-prescribed. Using staged iterative guideline-based care for hypertension, CREST-2 will characterize drug tolerance and stroke rates under these conditions.
TRIAL REGISTRATION: ClinicalTrials.gov Number NCT02089217.
Предметные рубрики MeSH
AgedAntihypertensive AgentsAsymptomatic DiseasesBlood PressureCarotid StenosisCross-Sectional StudiesDrug PrescriptionsDrug Therapy, CombinationDrug UtilizationFemaleGuideline AdherenceHumansHypertensionMaleMiddle AgedNorth AmericaPractice Guidelines as TopicPractice Patterns, Physicians'Randomized Controlled Trials as TopicSpainTreatment Outcome