What are the recent advances in the management of hypertension (high blood pressure)?

From the Guidelines

Recent advances in hypertension management prioritize personalized treatment approaches, emphasizing lifestyle modifications and optimized medication regimens to reduce cardiovascular risk. The current guidelines, as outlined in the 2022 World Health Organization guideline executive summary 1, focus on improving blood pressure control rates worldwide. Key recommendations include:

• Initiating pharmacological therapy based on accurate diagnosis and lifestyle modification counseling
• Setting blood pressure treatment targets and intervals for follow-up visits
• Choosing monotherapy or dual therapy, and using treatment algorithms for hypertension management
• Considering the strength of recommendations guided by the quality of underlying evidence, tradeoffs between desirable and undesirable effects, patient values, resource considerations, and cost-effectiveness

In terms of specific treatment options, first-line pharmacological treatment typically includes thiazide diuretics, calcium channel blockers, ACE inhibitors, or ARBs. The 2016 American Heart Association scientific statement 1 supports the use of these drug classes, noting that they have comparable effects on overall mortality, cardiovascular, cerebrovascular, and kidney outcomes. However, the choice of antihypertensive therapy should be individualized based on patient-specific factors, such as comorbidities, age, and race.

Some key points to consider in hypertension management include:

• Lifestyle modifications, such as reduced sodium intake, regular physical activity, weight management, and a DASH diet
• The importance of home blood pressure monitoring for diagnosis and treatment monitoring
• The use of single-pill combinations to improve adherence
• The introduction of combination therapy earlier for patients with BP >20/10 mmHg above target
• The potential benefits of device-based interventions, such as renal denervation, for treatment-resistant cases

Overall, the goal of hypertension management is to reduce cardiovascular risk through personalized treatment approaches, emphasizing lifestyle modifications, optimized medication regimens, and regular monitoring 1.

From the FDA Drug Label

Lowering blood pressure lowers the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions Numerous antihypertensive drugs, from a variety of pharmacologic classes and with different mechanisms of action, have been shown in randomized controlled trials to reduce cardiovascular morbidity and mortality, and it can be concluded that it is blood pressure reduction, and not some other pharmacologic property of the drugs, that is largely responsible for those benefits The largest and most consistent cardiovascular outcome benefit has been a reduction in the risk of stroke, but reductions in myocardial infarction and cardiovascular mortality also have been seen regularly Recent advances in hypertension management include the use of various antihypertensive drugs to reduce cardiovascular risk.

• The primary goal is to lower blood pressure to reduce the risk of fatal and non-fatal cardiovascular events, such as strokes and myocardial infarctions.
• Blood pressure reduction is the key factor responsible for the benefits, rather than other pharmacologic properties of the drugs.
• The largest benefit has been a reduction in the risk of stroke, with additional reductions in myocardial infarction and cardiovascular mortality also seen regularly 2.

From the Research

Recent Advances in Hypertension Management

• Hypertension is a significant health issue, affecting approximately 116 million adults in the US and over 1 billion adults worldwide, and is associated with an increased risk of cardiovascular disease (CVD) events and death 3.
• First-line therapy for hypertension includes lifestyle modification, such as weight loss, healthy dietary patterns, physical activity, and moderation or elimination of alcohol consumption, which can have additive effects and enhance the efficacy of pharmacologic therapy 3, 4, 5.
• The decision to initiate antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic CVD risk, with first-line drug therapy consisting of thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and calcium channel blockers 3.
• Randomized clinical trials have established the efficacy of blood pressure lowering to reduce the risk of CVD morbidity and mortality, with an SBP reduction of 10 mm Hg decreasing the risk of CVD events by approximately 20% to 30% 3.
• Lifestyle interventions, such as regular physical exercise, body weight management, and healthy dietary patterns, have been shown to be effective in preventing and treating hypertension, with physiological mechanisms underlying the beneficial effects including improvements in vascular health and reduced sympathetic overactivation 5.
• Therapeutic lifestyle changes, such as being active, weight loss, and consuming a diet rich in fruits and vegetables, have been effective in preventing or controlling stage 1 hypertension and may also be beneficial in patients with resistant hypertension 6.

Treatment Options

• Diuretics, calcium-blocking drugs, and angiotensin-converting enzyme inhibitors have been shown to be effective in lowering systolic blood pressure in elderly patients with previously untreated hypertension 7.
• Beta-blockers were found to be relatively ineffective, frequently contraindicated, and had more side effects compared to other treatment options 7.
• Combination therapy is often required to achieve goal blood pressure, with sequential monotherapy achieving target in 29% of patients 7.