Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Pharmacognosy wikipedia , lookup
Prescription costs wikipedia , lookup
National Institute for Health and Care Excellence wikipedia , lookup
Pharmaceutical industry wikipedia , lookup
Electronic prescribing wikipedia , lookup
Discovery and development of beta-blockers wikipedia , lookup
Theralizumab wikipedia , lookup
Clinical trial wikipedia , lookup
Watch pages Cardiovascular Therapeutics Watch Column Both individual patient and public health considerations are extremely important when addressing a health issue of the magnitude of hypertension, which, as noted in the previous column, was recently and authoritatively designated as the greatest threat to the global burden of disease. 1 While therapeutically beneficial interactions between individual patients and their physicians are the cornerstone of the practice of both behavioural medicine and biopharmaceutical medicine, professional organisations such as the European Society of Hypertension 2 and the American Society of Hypertension 3 are actively involved in preparing and publishing treatment guidelines and Position Papers to guide the treatment of hypertension. 4-6 Guidelines are also issued by governmental agencies. 7 systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013;380: 2224-2260. 2. European Society of Hypertension website. Available at: http://www.eshonline. org/ (Accessed 18th August, 2013). 3. American Society of Hypertension website. Available at: http://www.ash-us.org/ (Accessed 18th August, 2013). 4. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281-1357. 5. O’Brien E, Parati G, Stergiou G, et al: on behalf of the European Society of of Hypertension Working Group on Blood Pressure Monitoring. European Society of Hypertension Position Paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31:1731-1767. 6. American Society of Hypertension Position Papers. Available at: http://www.ash-us.org/ Publications/ASH-Position-Papers.aspx (Accessed 18th August, 2013). Through these guidelines and Position Papers, clinical research and individual clinical trials inform clinical practice and evidence-based medicine. Much research has been conducted on the blood pressure (BP) consequences of three related behavioural interventions: increasing physical activity, losing weight, and modifying dietary habits. 8,9 Accordingly, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) observes that “Adoption of healthy lifestyles by all persons is critical for the prevention of high BP and is an indispensable part of the management of those with hypertension.” 7 With regard to biopharmaceutical medicine, preapproval clinical trials bring new drugs to market and provide the information contained within each drug’s prescribing information (label). This information concerning the drug’s safety and therapeutic benefit (the best available information at the time of approval: additional information is gathered once a drug is being prescribed to patients) guides treatment decisions at the individual patient level. Also, as previously noted, clinical trials generate the evidence contained within treatment practice guidelines, which have a broader reach across populations of patients. 10 Ongoing and future clinical research in this therapeutic area therefore continues to influence the choice of target BPs for various patient populations and treatment algorithms. Since non-adherence to behavioural interventions is equally as problematic as non-adherence to biopharmaceutical interventions, 11-13 considerable research has been directed at ways of improving adherence, including educational programmes and the use of the internet. 14-16 While such strategies have been demonstrated to be successful in relatively small studies, the challenge is to make them successful on a much larger public health scale. A recent and very informative publication by Jennings is entitled “Recent clinical trials of hypertension management.” 17 It covers pharmacological and non-pharmacological interventions, and also the treatment of drug-resistant hypertension, a very ‘hot topic’ in the hypertension literature, and the topic of our next column. 7. US Department of Health and Human Services. The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Available at: http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf (Accessed 3rd July, 2013). 8. Shantha GP, Kumar AA, Kahan S, Cheah SY, Cheskin LJ. Intentional weight loss and dose reductions of antihypertensive medications: a retrospective cohort study. Cardiorenal Med. 2013;3(1):17-25. 9. Hassapidou M, Papadopoulou S, Vlahavas G, et al. Association of physical activity and sedentary lifestyle patterns with obesity and cardiometabolic comorbidities in Greek adults: Data from the National Epidemiological Survey. Hormones (Athens). 2012;12(2): 265-274. 10. Turner JR, Hoofwijk TJ. 1. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a 12 Journal for Clinical Studies trials in new drug development. 11. Turner JR, Strumph P. The moral imperative of improving patient adherence to pharmacotherapy for cardiodiabesity, Part I: A focus on type 2 diabetes mellitus. Journal for Patient Compliance. 2012;2(1):32-36. 12. Richards AL, Turner JR. The moral imperative of improving patient adherence to pharmacotherapy for cardiodiabesity, Part II: A focus on cardiovascular disease. Journal for Patient Compliance. 2012;2(2):36-41. 13. Turner JR. Patient and physician adherence in hypertension management. J Clin Hypertens (Greenwich). 2013;15:447-452. 14. Ferrara AL, Pacioni D, Di Fronzo V, et al. Lifestyle educational program strongly increases compliance to nonpharmacologic intervention in hypertensive patients: a 2-year follow-up study. J Clin Hypertens (Greenwich). 2012;14(11): 767-772. 15. Lauzière TA, Chevarie N, Poirier M, Utzschneider A, Bélanger M. Effects of an interdisciplinary education program on hypertension: A pilot study. Can J Cardiovasc Nurs. 2013;23(2): 12-19. 16. Liu S, Dunford SD, Leung YW, et al. Reducing blood pressure with Internet- based interventions: a meta-analysis. Can J Cardiol. 2013;29(5):613-621. 17. Jennings GLR. Recent clinical trials of hypertension management. Hypertension. 2013;62:3-7. J. Rick Turner, PhD, is Senior Scientific Director, Clinical Communications, Quintiles. He is also a Senior Fellow at the Center for Medicine in the Public Interest, and a Fellow of the Society of Behavioral Medicine. Email: [email protected]. Philip Galtry is Vice President and Cardiovascular Therapeutic Metabolic References Clinical J Clin Hypertens (Greenwich). 2013;15:306-309. Strategy Therapeutic Head, Cardiovascular Delivery Unit, and Quintiles. Philip holds an Honours degree in Biochemistry from the University of Bristol, UK, and has worked in the management of cardiovascular studies for almost 25 years. Volume 5 Issue 5