MORE ON THE TREATMENT OF HYPERTENSION
Having high blood pressure, myself, it makes me very curious about current research studies on hypertension. Four current studies on the subject attracted my attention and I would like to share them with my readers so that those with high blood pressure (BP) could better manage their health.
The first study published in prestigious medical journal N Eng J Med 2021 Aug 30, by Zang et al, entitled “Trial of Intensive Blood Pressure Control in Elder Patient with Hypertension”). In this study, 8,500 elderly hypertensive patients (age range 65 to 80) were randomized into two study groups. The first group had intensive treatment to reach target systolic BP to 110 to 130, and the second group (control group) was treated with standard treatment with systolic BP around 130 to 150 mmHg.
During a medium follow-up of 3.3 years, the end point outcome (which was stroke, acute coronary syndrome, heart failure and cardiovascular death rate) was significantly lower in the intensive treatment group than standard treatment group.
The take home message from this study is that intensive treatment of hypertension, despite causing the occasional hypotension and dizziness, is much more beneficial than standard treatment to prevent future catastrophic events.
The second study comes from China and was published in the same medical journal (e-pub Aug 2021). This large study involving 21,000 people (mean age 65) and the participants were randomized into two groups. The first group, in addition to their BP treatments, were given a salt substitute that contained 70% NaCl and 30% KCl. The control group was given regular salt. During a 5 year follow-up period, the mean systolic BP was 3.3 mmHg lower in the salt substitute group than in the control group.
The take home message from this study is that using salt substitute is better than regular salt to contro hypertension. However, serum potassium level should also be checked on occasions, to prevent hyperkalemia.
The third study comes from Portugal. Published in JAMA medical Journal (JAMA cardiol 2021 Aug). In this study, 60 middle-aged patients (mean age between 45 to 75) with resistant hypertension were recruited and assigned to a 12 – week moderate intensity aerobic exercise training, compared to a group without exercise training. The exercise group performed 40 minute exercise sessions per week. Compared to the control group, the exercise group had significant drop in their systolic as well as diastolic BP.
The take-home message from this study is that even though the study is small, if you exercise as a part of your high blood pressure management, your blood pressure medication dose will be less, and you can manage (even resistant) blood pressure better, thereby reducing the future risks of blood pressure related serious cardiovascular complications.
The fourth study published in Hypertension Journal (Hypertension 2021, Sep; 78:591) compared the effectiveness and safety of ACE (angiotensin-converting enzyme) inhibitor medications like Lisinopril with ARB (angiotensin receptor blocking) medications like Losartan.
The take-home message from this study is that even though both medications are just as effective, ARB medications have fewer side effects in the long run than ACE inhibitors. Therefore, it should be the preferred starting medication for initial treatment of hypertension.
