Cardiovascular Journal of Africa: Vol 32 No 6 (NOVEMBER/DECEMBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 6, November/December 2021 342 AFRICA Almost a fifth of hypertensives unknowingly take BP-raising meds: NHANES survey Almost a fifth of hypertensive patients may unknowingly be taking medications that raise blood pressure (BP), according to data from the US National Health and Nutrition Examination Survey (NHANES). Prevalence of such medication use was an overall 14.9% across survey cycles from 2009 to 2018, reaching 18.5% of adults with hypertension, reported Dr Timothy Anderson of Beth Israel Deaconess Medical Center in Boston and colleagues in the Journal of the American Medical Association Internal Medicine . BP-raising medications were determined according to the 2017 American College of Cardiology and American Heart Association guidelines. The most common ones taken by NHANES participants were antidepressants (8.7%), prescription non-steroidal anti-inflammatory drugs (NSAIDs, 6.5%), steroids (1.9%) and oestrogens (1.7%). ‘Most US adults with hypertension have not achieved recommended BP targets. One often-overlooked barrier to control is iatrogenic, or the medications known to raise BP. Given national trends of increasing polypharmacy, medications that raise BP may contribute to poor BP control rates and also worsen polypharmacy,’ the investigators said. Using these medications has been linked to greater use of anti-hypertensives in people with controlled and uncontrolled hypertension alike. Adults not concurrently taking anti- hypertensives were more likely to have uncontrolled hypertension if they were taking these drugs (OR: 1.24, 95% CI: 1.08–1.43). ‘Many medications known to raise BP have therapeutic alternatives without this adverse effect, for example, acetaminophen in place of NSAIDs and progestin-only or non-hormonal contraceptives in place of ethinyl estradiol- containing contraceptives,’ Anderson’s group noted. ‘Therefore, our findings indicate an important opportunity to improve BP control by optimising medication regimens, an approach with the potential to also reduce polypharmacy and medication regimen complexity,’ the authors suggested. ‘Clinicians caring for patients with hypertension should routinely screen for medications that may cause elevated BP and consider replacing them with safer therapeutic alternatives, and minimising the dose and duration of use when alternatives are not available,’ they said. The cross-sectional study included27599adult participants of NHANES (mean age 46.9 years; 50.9% women). Hypertension was defined as systolic BP 130 mmHg or higher or diastolic 80 mmHg or higher. The prevalence of hypertension and uncontrolled hypertension were 49.2 and 35.4%, respectively. Prescription medication use was obtained from home interviews in NHANES. Anderson and colleagues acknowledged their reliance on self-reported medication use and the lack of data on medication dose, duration and over- the-counter medication use. NHANES was the basis of a prior report suggesting a decline in both awareness and control of hypertension in recent years. Source: MedicalBrief 2021 tive doses in the treatment of advanced heart failure. Eur Heart J 2017; 19 : C8–C14. 14. Silvetti S, Nieminen MS. Repeated or intermittent levosimendan treat- ment in advanced heart failure: an updated meta-analysis. Int J Cardiol 2016; 202 : 138–143. 15. Altenberger J, Parissis JT, Costard-Jaeckle A, et al . Efficacy and safety of the pulsed infusions of levosimendan in outpatients with advanced heart failure (LevoRep) study: a multicentre randomized trial. Eur J Heart Fail 2014; 16 : 898–906.