BACKGROUND: High-risk hypertensive patients often need immediate and more aggressive treatment to achieve adequate blood pressure (BP) control. There is currently no available Philippine data on the level of BP control and management specific to high-risk patients.
OBJECTIVE: Primary Objective: To determine the prevalence of BP control in high-risk hypertensive patients.
Secondary Objectives:
1. To observe treatment pattern prescribed for high-risk hypertensive patients with uncontrolled BP.
2. To observe the change in BP after eight weeks of planned treatment modification.
METHODS: This was a multicenter, observational disease registry of high-risk hypertensive patients based on the 2007 European Society of Hypertension/European Society of Cardiology guidelines. The study had two cross-sectional phases. Patient data, including level of BP control and any prescribed treatment modification, were collected on the first visit (V1). A second evaluation was done after eight weeks for patients with planned treatment modification (V2).
RESULTS: In 804 patients with high-risk hypertension included in V1, only 37 patients (4.6%) had a baseline BP <130/80 mmHg. Treatment modification was planned in most patients by switching (352/804, 44%), adding antihypertensive agents (193/804, 24%) or increasing the treatment dose (33/804, 4.10%). Of the 325 patients with planned treatment modification evaluated at V2, 112 (34%) had no change in baseline treatment. After a mean treatment period of 5.66 weeks, there was a significant decrease from baseline in mean systolic (-23.95 mmHg) and diastolic (-9.26 mmHg) BP (both p<0.0001). Among patients followed-up, 90% (294/325) achieved target systolic or diastolic BP levels, while 70% (228/325) achieved both target systolic and diastolic BP levels at study completion.
CONCLUSION: BP control in high-risk hypertensive Filipinos is low. Most physicians modified treatment in patients with uncontrolled BP and this was effective in significantly lowering BP. However, larger trials based on current treatment guidelines for hypertension are needed to compare the relative benefits of different types of treatment modification.

Human ; Male ; Female ; Antihypertensive Agents ; Blood Pressure ; Prevalence ; Hypertension ; Systole ; Treatment Outcome ; Physicians ; Registries

BACKGROUND: Morbidity and mortality from acute coronary syndrome (ACS) primarily depends on prompt evaluation and management of patients. Despite available recommendations on ACS management, there is limited data regarding Filipino physician's knowledge and adherence with these guidelines in the emergency room (ER).
OBJECTIVES: To describe the initial management of ACS patients by Filipino physicians at the ER and to document their adherence with the 2007 American College of Cardiology/American Heart Association (ACC/AHA) ACS guidelines for the management of patients with unstable angina (UA)/ non-ST-segment elevation myocardial infraction (NSTEMI) and ST-segment elevation myocardial infraction (STEMI).
METHODS: This was an open-label, descriptive, multicenter, non-interventional study that enrolled patients ? 18 years of age, seen at the ER and suspected to have UA or MI with or without ST-segment elevation. Patient demographics, medical history, physical and laboratory examinations, medications or interventions done at the ER and the specialty of physicians who provided the initial management were recorded. Adherence with the 2007 ACC/AHAACS guidelines was also assessed. Data were summarized using descriptive statistics.
RESULTS: A total of 1,398 eligible patients (mean age 61.58+ 12.03 years) were included in the study. At least one cardiac enzyme test was requested in up to 93% of patients, with troponin I being the most common (72.53%). Upon diagnosis, 95.78% of patients were given antiplatelet therapy (16.95% clopidogrel alone, 15.31% aspirin alone and 1.07% other antiplatelet drugs), the combination therapy. Moreover, 86.27% were given anticoagulant therapy (75.75% enoxaparin, 5.94% fondaprinux and 3.97% IV UFH). Ninety-eight percent of patients we subsequently admitted in the hospital and 26.68% of patients were considered to undergo percutaneous coronary intervention (PCI). Majority of these patients were initially managed by ER physicians (52.22%).
CONCLUSION: Filipino physicians at the ER provide an appropriate management strategy to individual ACS patients because their management adheres to the 2007 and the current ACC/AHA ACS guidelines. The outcome and impact of these strategies should be assessed to encourage more physicians to conform with available recommendations. Moreover, a review of adherence of physicians to other disease management guidelines should be conducted to further improve care and outcomes in ER.

Human ; Male ; Female ; Aged ; Middle Aged ; Acute Coronary Syndrome ; American Heart Association ; Angina, Unstable ; Anticoagulants ; Aspirin ; Disease Management ; Emergency Service, Hospital ; Enoxaparin ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors ; Ticlopidine ; Troponin I ; United States ; Myocardial Infarction

BACKGROUND: Insulin glulisine  is a  new  rapid-acting insulin  analogue.  Currently,  few  data   are   available on its safety and tolerability among patients in the Asia-Pacific   region.
OBJECTIVES:
Primary Objective: To assess the safety and tolerability of insulin glulisine as part of an insulin treatment   regimen   in   Filipinos   with   diabetes
Secondary  Objectives:
1.    To compare the change in glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG) and post-prandial blood glucose (PPBG) levels at baseline and after  three  and  six months on an insulin treatment regimen with insulin  glulisine
2.    To measure patients' level of  satisfaction  in  using   the   Insulin   glulisine  pen
METHODS: This was a multicenter, observational, post- marketing  surveillance  study   of   adult   patients   (18   to Results: Among 1,805 patients included, 132 (7.31%) experienced hypoglycemia. The overall incidence of adverse events other than hypoglycemia was 0.78%. There  was  a  significant  reduction  in   baseline  levels   of HbA1c,  FBG  and  PPBG  during  the  follow-up  visits  at third and sixth months (all p<0.0001). Patient satisfaction  with  using  the  pen  was  good  to    excellent.
CONCLUSION: This post-marketing surveillance study demonstrates the safety and tolerability of  insulin  glulisine  when  used   as   part   of   an   insulin   regimen in an actual clinical setting for the management of diabetes among Filipino  patients.  Insulin  glulisine  as  part of  a   diabetes  treatment  regimen  was   effective  in improving glycemic  parameters.  The  glulisine  pen  was   also   well   tolerated   and   accepted   by patients.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Hemoglobin A, Glycosylated ; Insulin Glulisine ; Diabetes Mellitus, Type 2 ; Insulin, Short-acting ; Excipients ; Fasting ; Insulin ; Hypoglycemia