title: Temporal trends in management of hypertension among Israeli adults, 2002-2010: lesson from the Acute Coronary Syndromes Israeli Survey (ACSIS).
abstract: Our aim was to evaluate trends in blood pressure (BP) management and BP levels among patients admitted with acute coronary syndromes (ACS) over the past decade. The study population comprised 7658 ACS patients enrolled in the Acute Coronary Syndromes Israeli Survey (ACSIS) between 2002 and 2010. We compared patients' characteristics, admission systolic BP levels, and antihypertensive therapy between those hospitalized during the early (years: 2002-2004) and late (years: 2008-2010) periods. Among 7658 study participants, 4421 (58%) were hypertensive. Hypertensive patients presenting from 2008 to 2010 tended to exhibit lower BP levels (P < .001). The use of angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB) and beta-blockers has increased over the years (P < .001 for both), whereas the use of diuretics and calcium antagonists has remained stable (P = .77 for both). The use of diuretics tended to increase in hypertensive subjects without prior cardiovascular disease (P = .05). In addition, the late period was characterized by a significant increase in the use of two or more antihypertensive agents (combination therapy) compared with the early period (57% vs 50%; P < .001). BP levels decreased among Israeli hypertensive patients presenting with ACS between 2002 and 2010, possibly due to increased use of ACEi/ARB, and combination therapies during this time period.
authors.affiliation: Department of Internal Medicine D and Hypertension Unit, the Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; The Dr. Pinchas Borenstein Talpiot Medical Leadership Program, 2013, the Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Gadi
authors.initials: G
authors.lastname: Shlomai
authors.affiliation: Heart Institute and the Neufeld Cardiac Research Institute Leviev Heart Center, the Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Kopel
authors.affiliation: Heart Institute and the Neufeld Cardiac Research Institute Leviev Heart Center, the Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Department of Internal Medicine D and Hypertension Unit, the Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: grosse@post.tau.ac.il.
authors.forename: Ehud
authors.initials: E
authors.lastname: Grossman
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D000368:Aged; D000959:Antihypertensive Agents / Q000145:classification / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D015897:Comorbidity; D003710:Demography; D019468:Disease Management; D004359:Drug Therapy, Combination / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006334:Heart Function Tests; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D007557:Israel / Q000453:epidemiology; D008297:Male; D054539:Medication Therapy Management; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents
keywords: Treatment of hypertension; blockers of the rennin angiotensin system; combination therapy