What’s new in Hypertension?
‘Hypertension is not a boring subject…high blood pressure remains a common cause of morbidity and mortality across Europe due to stroke, heart failure and renal disease’, said Dr Thierry Christiaens (Gent, Belgium). He went on to highlight recent advances in hypertension research such as self-monitoring, non-drug treatment and randomised controlled trials which had looking at drug combinations and the effect of tighter blood pressure control.
The TASMINH2 study recently published in the Lancet took patients aged 35-85 years with a blood pressure above 140/90 despite initial antihypertensive treatment and randomised them to self monitor blood pressure and self titrate antihypertensive medications or to usual care. At six months, systolic blood pressure was 3.7mmHg lower and at 12 months was 5.4mmHg lower in the intervention compared to the control group. However only a small proportion of participants invited agreed to take part in the study which could mean that this method of blood pressure control is only suited to a particular group of the population. ‘Those who are more socially deprived may be less successful in this approach’ said Dr Christiaens.
Non drug treatments for hypertension include the Dietary Approaches to Stop Hypetension (DASH) diet which is rich in fruits, vegetables, low fat dairy and reduced fat and cholesterol. Patients following the DASH diet have a significantly lower blood pressure compared to those on a usual diet. Dr Christiaens also reviewed the results of some large randomised controlled trials investigating optimal blood pressure control. The ACCOMPLISH study compared antihypertensive combinations in diabetic patients with hypertension. Patients treated with benazepril and amlodipine had significantly lower rates of the composite primary end point (myocardial infarction, stroke, revascularisation, hospitalisation and death) compared to those receiving benazepril and hydrochlorothiazide suggesting a possible beneficial effect of calcium channel blockers over thiazides when used in combination with an ACE inhibitor. He also discussed the issue of achieving tighter blood pressure control in high risk patients and the results of the ACCORD and INVEST trials which suggested a target of a systolic blood pressure below 130 mmHg may be harmful in this group.
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Dr. Thierry Christiaens,
Gent
Belgium