Over 60% Of Patients With Seemingly Well Controlled Blood Pressure (BP) Are Not Controlled Over 24-hours

Main Category: Hypertension
Article Date: 19 Jun 2007 - 1:00 PST

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The results from two large, multinational, practice-based observational studies in blood pressure were announced today at the Annual European Society of Hypertension (ESH). Results of the SURGE study show that measuring blood pressure in a doctor's office alone does not provide an accurate picture of a patient's blood pressure control - more than half of the patients who appeared to have well controlled blood pressure were shown to be uncontrolled over 24 hours.1,2 In a second study, SURGE-2, treatment with telmisartan, a long-acting blood pressure lowering treatment, or telmisartan + HCTZ, achieved morning BP control (6 - 11.59am), in up to 64% of patients3,4 a time when BP is known to surge.5 There is a well recognised relationship between uncontrolled hypertension and cardiovascular disease risk.6

SURGE - an observational study to assess blood pressure control in hypertensive patients

Results from the SURGE hypertension study, demonstrate that:1,2

-- More than 60% of patients do not have controlled (<135/85mmHg, ESH/ESC) blood pressure in the morning when measured by home blood pressure monitoring (HBPM).

-- More than 60% of patients are not able to achieve control of blood pressure over a 24-hour period, when measured by ambulatory blood pressure (ABPM), which monitors control over the full 24-hour period.

Dr Sarah Jarvis, GP, London, commented, "Despite the recent advances in hypertension management in the UK, the need for good 24-hour BP control is often underestimated in practice. So it's not surprising to see in this 'real life setting' study that, despite receiving treatment, a large proportion of patients still have poorly controlled BP at some point in the day, putting them at increased risk of cardiovascular events. It is simply not practical or possible to use ABPM or even HBPM for every patient - what we really need are reliable therapies that provide consistent control over a full 24 - hour period."

SURGE-2 - a surveillance study of the efficacy of telmisartan ± HCTZ treatment in reducing early morning blood pressure under real clinical conditions

SURGE-2, an 8-week, open-label prospective observational study of >26,000 patients with hypertension (office blood pressure >140/90mmHg) - the largest practice-based study ever conducted in hypertension using this methodology - demonstrate that telmisartan provides powerful blood pressure control over a full 24-hour period, including the risky early morning hours3,4:

-- The mean morning ABP was significantly reduced by telmisartan alone and in combination with HCTZ by -8.2/-4.9 mmHg (p<0.001), almost doubling the number of patients with controlled blood pressure from 36.5% to 64.4% with telmisartan + HCTZ (<135/85mmHg, ESH/ESC) after 8 weeks of treatment.

-- The 24-hour ABP was reduced by telmisartan alone and in combination with HCTZ by -7.85/-4.7 mmHg (p<0.001).

Professor Gianfranco Parati, University of Milano-Bicocca, Italy, Chair of the SURGE Steering Committee commented, "The results from SURGE-2 are particularly encouraging. They demonstrate that, unlike many other antihypertensive treatments, in telmisartan we have a treatment option that does provide smooth blood pressure control from morning to morning."

Clinical trials have already shown that telmisartan provides effective blood pressure reduction over a full 24 hour period.7-10 The SURGE studies (SURGE and SURGE-2) are part of an extensive ongoing clinical trial programme investigating the effects of telmisartan compared with other treatments for hypertension, including other available ARBs.

About the SURGE studies:

-- SURGE - Survey with HBPM and ABPM Under Real clinical conditions in General practice to Evaluate blood pressure control in the early morning. An observational study to assess early morning blood pressure control in hypertensive patients

-- SURGE-2 - Study of a hypertensive population Under treatment with Telmisartan in Real clinical conditions with the Goal of controlling Early morning blood pressure rise. A surveillance study of the efficacy of telmisartan treatment in reducing early morning blood pressure under real clinical conditions.

About Hypertension

-- Hypertension is defined in the UK as a level of blood pressure higher than 140/90 mmHg, and affects over 16 million people in the UK alone.11

-- Hypertension is a major but modifiable contributory factor in cardiovascular disease such as stroke and coronary heart disease.11

-- High blood pressure rarely causes symptoms and people are usually unaware that they have it until they have their blood pressure checked.

Boehringer Ingelheim

The Boehringer Ingelheim group is one of the world's 20 leading pharmaceutical companies. Headquartered in Ingelheim, Germany, it operates globally with 137 affiliates in 47 countries and 38,400 employees. Since it was founded in 1885, the family-owned company has been committed to researching, developing, manufacturing and marketing novel products of high therapeutic value for human and veterinary medicine.

In 2006, Boehringer Ingelheim posted net sales of 10.6 billion euro while spending one fifth of net sales in its largest business segment Prescription Medicines on research and development.

For more information please visit http://www.boehringer-ingelheim.com

Micardis® (telmisartan) prescribing information (UK)

Tablets containing 20, 40 or 80mg telmisartan, a specific angiotensin II receptor (type AT1) antagonist. Indication: essential hypertension. Dose: adults only: usually 40mg once daily, range 20-80mg. Can be used together with thiazide-type diuretics. Maximum antihypertensive effect takes 4-8 weeks to develop. Maximum dose in mild to moderate hepatic impairment 40mg. A starting dose of 20mg is recommended in severe renal impairment or haemodialysis. Contra-indications: hypersensitivity to any of the ingredients; pregnancy and lactation; biliary obstructive disorders; severe hepatic impairment. Precautions: hepatic impairment; renovascular hypertension; renal impairment & kidney transplant; intravascular hypovolaemia; renin-angiotensin-aldosterone system stimulation; primary aldosteronism; aortic or mitral valve stenosis; obstructive hypertrophic cardiomyopathy; hyperkalaemia; fructose intolerance; ischaemic cardiopathy or ischaemic cardiovascular disease. Apparently less effective in black patients than in other racial groups.

Interactions: lithium; medicinal products that may increase potassium levels or induce hyperkalaemia; NSAIDs; diuretics; other antihypertensive agents; baclofen; amifostine; alcohol; barbiturates; narcotics; antidepressants; systemic corticosteroids. Side-effects: In clinical trials the following effects have been reported commonly (≥ 1/100, < 1/10),: urinary tract infections; upper respiratory tract infections including pharyngitis & sinusitis; abdominal pain; diarrhoea; dyspepsia; eczema; arthralgia; back pain; muscle spasms or pain in extremities; myalgia; chest pain; influenza-like illness. Uncommonly (≥ 1/1000, < 1/100), anxiety; visual disturbances; vertigo; dry mouth, flatulence; hyperhydrosis; tendonitis have been reported. Rarely (≥ 1/10,000, < 1/1,000), stomach discomfort has been reported. Since the introduction of telmisartan to the market, reported side-effects have included: erythema; pruritis; syncope; insomnia; depression; vomiting; hypotension; bradycardia; tachycardia; abnormal hepatic function; liver disorder; renal impairment; hyperkalaemia; dyspnoea; anaemia; eosinophilia; thrombocytopenia; asthenia; lack of efficacy. Isolated cases of angioneurotic oedema and urticaria have also been reported. Infrequently, a decrease in haemoglobin or an increase in uric acid have been observed. Cases of increased blood CPK have also been reported. Prescribers should consult the Summary of Product Characteristics in relation to other side-effects. Presentations and NHS price: blister packs of 28 tablets, 20mg £11.34 EU/1/98/090/010; 40mg £11.34 EU/1/98/090/002; 80mg £14.18 EU/1/98/090/006 Prescription only. Marketing authorisation holder: Boehringer Ingelheim International GmbH, D-55216 Ingelheim am Rhein, Germany. Prepared May 2007.

For full prescribing information please see Summary of Product Characteristics. For further information please contact Boehringer Ingelheim Ltd, Ellesfield Avenue, Bracknell, Berkshire, United Kingdom. RG12 8YS. Micardis® is a registered trademark.

Adverse events should be reported to Boehringer Ingelheim Drug Safety on 0800 328 1627 (freephone). Information about adverse event reporting can be found at http://www.yellowcard.gov.uk

References

1. Parati G et al. Morning and smooth 24 hour ambulatory blood pressure control is not achieved in high risk patients with hypertension: results from the SURGE observational study. Presented at the Annual Meeting of the European Society of Hypertension. June 2007, Milan, Italy.

2. Redon J et al. Home blood pressure control is low during the critical morning hours in patients with hypertension and even worse in high-risk patients with diabetes and left ventricular hypertrophy: results from the SURGE observational study. Presented at the Annual Meeting of the European Society of Hypertension. June 2007, Milan, Italy.

3. Parati G et al. Telmisartan improves and maintains smooth ambulatory blood pressure control over 24 hours in the morning: Results from a practice based study (SURGE-2). Presented at the Annual Meeting of the European Society of Hypertension. June 2007, Milan, Italy.

4. Redon J et al. Telmisartan procudes smooth home blood pressure reduction, even during the critical early morning hours: results from a post-marketing study (SURGE-2). Presented at the Annual Meeting of the European Society of Hypertension. June 2007, Milan, Italy.

5. Schacter M. The British Journal of Cardiology; 11(4): 287-290

6. Williams et al. Journal of Human Hypertension 2004 Mar;18(3):139-85.

7. Burnier M, Brunner HR. Lancet 2000; 355: 637-45.

8. Brunner HR. J Hum Hypertens 2002; 16 (suppl 2): S13-S16.

9. Neutel JM, Smith HG. J Clin Hypertens 2003; 5 (1): 58-63.

10. Millar-Craig MW et al. Lancet 1978; 795-97.

The Blood Pressure Association: Please click here. Accessed 7 June 2007.

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