Hypertension最新文献

Background: Fixed-dose combination of semaglutide/cagrilintide (CagriSema 2.4 mg/2.4 mg) has demonstrated significant and clinically relevant body weight reductions in adults with overweight or obesity compared with placebo.

Methods: The phase 3a, 68-week REDEFINE 1 trial randomized adults without diabetes with body mass index ≥30 kg/m², or ≥27 kg/m² with ≥1 obesity-related complication, to once-weekly CagriSema 2.4 mg/2.4 mg, semaglutide 2.4 mg, cagrilintide 2.4 mg, or placebo, plus lifestyle intervention. Secondary and post hoc analyses evaluated the antihypertensive effect from REDEFINE 1, focusing on CagriSema and placebo groups, by subgroup/category, including baseline body mass index, the presence of hypertension or resistant hypertension at baseline, and concomitant changes in the use of antihypertensive medications.

Results: Overall, 3417 participants underwent randomization; CagriSema: n=2108, semaglutide: n=302, cagrilintide: n=302, and placebo: n=705. Changes from baseline to week 68 in blood pressure (BP) were greater with CagriSema versus placebo (systolic BP: -10.9 versus -2.8 mm Hg; diastolic BP: -5.4 versus -1.7 mm Hg, respectively). The proportion of participants reaching BP targets at week 68 was 63.0% and 32.0% for CagriSema and placebo, respectively. The proportion of participants with resistant hypertension at baseline (n=167) that reached BP targets at week 68 was 42.0% and 29.3% for CagriSema and placebo, respectively (odds ratio, 1.7 [95% CI, 0.7-4.4]). Among participants who used antihypertensive medication during the study, 39.6% in the CagriSema group decreased or stopped treatment from week 0 to week 68 versus 18.8% with placebo.

Conclusions: CagriSema presents clinically relevant reductions in BP across a wide range of participant subgroups, including those with resistant hypertension.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05567796.

Background: Understanding the association between improving medication adherence, intensifying antihypertensive medications, or both on blood pressure (BP) control can guide clinical care and quality improvement.

Methods: Retrospective cohort study of primary care patients with hypertension and 2 uncontrolled BP readings in 2021. Using prescription fills, we classified patients as high (≥80%) versus low (<80%) adherence in the 6 months before and after their second uncontrolled reading (aka index visit). We defined intensification as a prescription for a higher dose or a new medication class at that visit. The outcome was BP control (<130/80 mm Hg) between 30 and 270 days afterward. We identified factors associated with intensification at the index visit. For patients with low adherence before the index visit, we used multilevel logistic regression to measure the association between intensification, postvisit adherence, and subsequent BP control.

Results: Of 27 699 patients with uncontrolled BP, 24% had low adherence before the index visit. Patients with high adherence and prior intensification had the highest adjusted probability of intensification (28% [95% CI, 27%-29%]). Among patients with low previsit adherence, 19% received intensification and 46% transitioned to high adherence. Without intensification or improved adherence, the adjusted probability of control was 23%. Neither intensification alone (24%) nor improved adherence alone (25%) significantly increased the adjusted probability of control. Patients who both received intensification and improved adherence had the highest adjusted probability of control (31%; P<0.01 versus no action).

Conclusions: Physicians should simultaneously intensify treatment and encourage adherence. Health systems should encourage intensification regardless of adherence status.