OBJECTIVE: The EXforge Clinical evaluation of amlodlpine and valsarTan in hypErtension (EXCITE) study was designed to evaluate the real-world effectiveness and safety of amlodipine/valsartan (Aml/Val) and amlodipine/valsartan/hydrochlorothiazide (Aml/Val/HCT) single-pill combination (SPC) in patients with hypertension.
METHODOLOGY: This 26-week observational, multicenter, prospective, open-label study included patients aged ? 18 years of age with established diagnosis of hypertension. The change in mean sitting systolic BP (msSBP), diastolic BP (msDBP) from baseline to Week 26, proportion of patients achieving BP goal (msSBP/msDBP <130/80 mmHg and <140/90 mmHg for patients with and without diabetes,respectively) at endpoint, and safety were monitored. Here, we report the data of patients from the Philippines.
RESULTS: Of the total 1,054 patients in the full analysis set (Aml/Val, n=928; Aml/Val/HCTZ, n=126), 923 (87.6%) patients completed the study. The baseline BP was 158.5/96.5 and 167.0/99.5 mmHg in the Aml/Val and Aml/Val/HCTZ groups,respectively. Significant reductions in msSBP and msDBP from baseline to week 26 were observed with both Aml/Val (-31.9/-19.2 mmHg). Adverse events were reported by 8.8% of the patients.
CONCLUSION: The Aml/Val and Aml/Val/HCTZ SPCs were effective in controlling BP and were generally well tolerated in patients with hypertension from the Philippines.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Amlodipine ; Amlodipine, Valsartan Drug Combination ; Diabetes Mellitus ; Hydrochlorothiazide ; Hypertension ; Philippines ; Tetrazoles ; Valine ; Valsartan

BACKGROUND

Hypertension is one of the leading causes of cardiovascular morbidity and mortality in the Philippines. The prevalence rate of hypertension has been increasing, and this was associated with increasing comorbidities and poor control rates. The Philippine Heart Association-Council on Hypertension has been conducting the PRESYON studies since 1992 to determine the present hypertension rates. This updated PRESYON-4 aimed to know the latest numbers of hypertension cases in the country and to determine the awareness, treatment profile, and control rates of individuals afflicted with hypertension.

METHODS

PRESYON-4 is a randomized, prospective, multistage, stratified, nationwide survey conducted last January to April 2021. It included 3,437 participants; 2,796 subjects were adults aged 19 years or older, and the rest of the participants were 12 to 18 years old. The prevalence of hypertension was analyzed from the survey. Anthropometric measurements, risk factors, and comorbidity assessment were also determined.

RESULTS

The prevalence rate of hypertension in the latest survey is 37%, with more than half of the respondents aware of their disease. Utilizing the classification of the European guidelines for hypertension, 34% had grade 1 hypertension, with 26% of participants having isolated systolic hypertension. Individuals older than 50 years are aware of their elevated blood pressure (BP), but more females are aware of their disease compared with men. Current smoking and obesity are high in the hypertensive population, whereas diabetes mellitus and angina are the more common comorbidities. Most subjects utilize the oscillometric arm BP apparatus to monitor their BP. Angiotensin receptor blockers are the most used antihypertensive medication with a high compliance rate. However, there is poor control among treated patients with hypertension, as the control rate is only 39%. The prescription of a single drug is still prevalent among Filipino hypertensive individuals.

CONCLUSION

The point prevalence of hypertension in the country is at 37% based on the analysis. The need to manage risk factors such as obesity and smoking should be part of management. A multisectoral approach in the management of hypertension should be part of the strategy to lower hypertension in the country.

Hypertension ; prevalence ; Awareness ; Compliance

Diabetes remains as the 6th leading cause of death in the Philippines, with more than 33,000 deaths in 2016. Given this alarming prevalence, it is imperative that this public health concern be prioritized in the country and to answer such concern, a group of cardiologists and endocrinologists who are in active clinical practice and research, formed a technical working group composed of five members. Their primary objective was to develop an evidence-based consensus document for Filipino healthcare practitioners and people in the academe that would serve as a guideline on the approach to lower the CV risk of individuals with T2DM. The TWG agreed on focusing with the pharmacological approach to treatment of lowering CV risk for T2DM patients using the ADAPTE model which is a more systematic approach to guideline adaptation. The recommendations were developed using the ADAPTE framework appraising all international practice guidelines and recommendations through to 2013. The technical working group’s overall objective of guideline adaptation is to take advantage of the existing guidelines to enhance the efficient production and use of high-quality adapted guidelines specially in the local Philippine setting. Each of these articles was then assessed using the AGREE instrument. Based on the key questions that the technical working group had identified regarding the approach to lower the risk of individuals with type 2 diabetes, 9 recommendations concerning the antidiabetic drug of choice for persons with type 2 diabetes with or without established ASCVD and management of type 2 diabetes mellitus patients with hypertension and dyslipidemia were drafted and are presented in this report.
Diabetes Mellitus, Type 2 ; Heart Disease Risk Factors